1 addressing racial & ethnic disparities in health care ahrq 2007 annual conference september...

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Addressing Racial & Ethnic

Disparities in Health Care

AHRQ 2007 Annual Conference

September 28, 2007

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Overview of Our Efforts

•Activities span from 2004 to 2006

•Participant in the National Health Plan Collaborative Phase I and II

•Efforts include quality improvement activities with inter-departmental collaboration

•Our activities have been primarily focused on: - Data Analysis and Collection- Member & Provider Interventions- Community Partnerships / Grants- Organizational Collaboration

•Most of our disparity-focused clinical interventions are for diabetes and asthma

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Participation in the National Health Plan

Collaborative:

Phase I and Phase II

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National Health Plan Collaborative

• Phase I: 9/2004 to 6/2006; Phase II: 10/2006 to 6/2008.

• Public-private partnership initially nine health insurance companies; now ten health plans participating.

• Technical assistance provided by Center for Health Care Strategies, Institute for Healthcare Improvement (Phase I) and RAND Corporation

• Supported by the Agency for Healthcare Research and Quality and the Robert Wood Johnson Foundation

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NHPC Phase I and II

Phase I• Health plans focused

on data collection & examination of diabetes performance data for disparities.

• Five plans implemented one or more pilot interventions.

Phase IIHealth plans focus on:• Primary data

collection• Improving language

access • Determination of the

business case and ROI for disparity reduction

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NHPC: How health plans can achieve success in addressing disparities

Community & Member Engagement

Q.I. Infrastructure

ITInfrastructure

Provider Engagement

Leadership

Public-Private Partner-

ships

Corporate/Business Case

Alignment

LearningCollaborative

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Our Efforts: Information Sharing

•DATA STRATEGIES

•MEMBER & PROVIDER STRATEGIES

•COMMUNITY PARTNERSHIPS & GRANTS

•ORGANIZATIONAL COLLABORATION

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Data Strategies

•“Indirect”- Geocoding and surname analysis of HEDIS® measures (2004 to present)

• “Direct” - Voluntary collection of self-identified race, ethnicity and language preference (2006 to present)

Dual approach:

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Results: Indirect Data Analysis

Diabetes (adults) Blacks & Hispanics less likely to get HbA1c and LDL tests

Asthma (children) Black children less likely to have appropriate use of

medications

Prevention (adults) Black women less likely to get breast cancer

screening.

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Voluntary Data Collection

All Lines of Business

“Opt out” Option

Self-Identified

Voluntary

Confidential

Data Use: QI

Race

Ethnicity

Language

2006

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Provider and Member Strategies: Quality Management

• Office-based education to targeted provider office staff located in targeted low income Zip codes (2004).

• Provider & member newsletters addressing disparities and diabetes care (2005, 2006).

• Physician-focused discussion on improving diabetes care (2005, 2006).

• Interactive voice recognition telephonic outreach to diabetic members with an added focus on potential needs of the minority population (2006).

• Letters on physician letterhead reminding patients regarding needed testing (2006).

• Targeted asthma education for offices with identified disparities (Spring, 2006).

• “Shoot For Your Good Health” asthma basketball camp for kids with asthma, ages 8 to 14 (2005, 2006).

• Creation of Expert Advisory Panel (2007).

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Organizational and Community Strategies

• Health Care Disparities / Culturally Appropriate Linguistic Services Committee created in 2005. This multi-departmental committee meets bimonthly to discuss initiatives to address health disparities, cultural, and linguistic issues.

• Cultural competency training for clinical staff (physicians, nurses and customer service staff) in 2007 using e-learning based tool.

• Highmark funds numerous grants to promote health and well-being in communities throughout our 49-county service area. Some disparity reduction grants provide support for health and dental programs that support healthy lifestyles, chronic disease management, health screenings in underserved communities, and informational events.

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Other Current Activities

Case Management Exploring opportunities for Culturally

tailored outreach

Community Academia, others

Partnerships

External FundingApplied for RWJF grant with RAND

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Results and Lessons Learned

SELECTED OUTCOMES

• 2006: Impact of diabetes screening reminders for non-adherent members - after 90 days 44% members had at least one test done after the reminder; 23% had all three tests (HbA1c, LDL-C, microalbumin test).

• 2004: Impact of in-office education regarding diabetes disparities and importance of screening - HEDIS® 2005 did not show improvement in LDL testing rates in Medicare Advantage HMO pilot PCP practice sites who received education.

SELECTED LESSONS LEARNED

• Engagement of senior management is critical.• Collaborate, collaborate! Internal and external. • Network physicians supportive of our efforts. • Lag time: data analysis, use of data.• Dedicated resources is critical.• Limited evidence to guide efforts.

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Questions?Contact:

rhonda.moore.johnson@highmark.com??

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Highmark in Motion