esther s. han, mph senior health care analyst, research july 15, 2009 innovative practices in...
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Esther S. Han, MPHSenior Health Care Analyst, Research
July 15, 2009
Innovative Practices in Multicultural Innovative Practices in Multicultural Health Care: Health Plan InitiativesHealth Care: Health Plan Initiatives
© 2008 National Committee for Quality Assurance
Session Agenda
• Introductions• An Overview of NCQA’s Efforts to
Narrow Disparities in Care• NCQA’s Recognizing Innovation in
Multicultural Health Care Award Program
• Keystone Mercy Health Plan• Virginia Premier Health Plan• Q&A
© 2008 National Committee for Quality Assurance
NCQA: A Brief Introduction
• Private, independent non-profit health care quality oversight organization founded in 1990
• Mission: To improve the quality of health care
• Committed to measurement, transparency and accountability
• Unites diverse groups around common goal: improving health care quality
© 2008 National Committee for Quality Assurance
Achieving the Mission
• 70% of all insured Americans are in NCQA-Accredited plans– 109 million people including 92% of people in HMOs
• Over 90% of managed care organizations report HEDIS® quality data
• Over 14,000 physicians have earned NCQA Recognition; our RPs form the basis of quality improvement programs nationwide
• 38 states and the federal government rely on NCQA Accreditation and HEDIS
• Blend of standards and performance measures unique to achieving success in NCQA programs
HEDIS® is a registered trademark of NCQA.
© 2008 National Committee for Quality Assurance
NCQA Efforts in Cultural Competence/Disparities
• NCQA has focused on racial/ethnic disparities since 2003
• Our efforts include the following:– Innovation in Multicultural Health Care Awards
program– Multicultural Health Care: A Quality
Improvement Guide– Technical Assistance Project for practices
services minority populations– Developing standards for culturally and
linguistically appropriate services
© 2008 National Committee for Quality Assurance
Multicultural Health Care: A Quality Improvement Guide
© 2008 National Committee for Quality Assurance
Supporting Small Practices: Lessons for Health Reform
• Lack of resources, business management skills
• Lower patient adherence to treatment plans
• Language and communication barriers• Lack of sophistication with technology • Inability to track and manage patient
needs and outcomes • Staff turnover
www.ncqa.org/smallpractices
© 2008 National Committee for Quality Assurance
New Standards to Address Areas for Organizations to Improve Care
• Race/ethnicity and language data– Data elements, methodology, storage and protection– Reporting and use of data to improve quality and enhance
culturally appropriate care
• Language Services– Provision, monitoring, and evaluation of services
• Network and Workforce Diversity– Improve ability to serve culturally and linguistically diverse
members
• Accountability and Quality Improvement– Program structure and systems to address CLAS and reduce
disparities– Using data to assess disparities and language services and
designing interventions to reduce disparities and improve CLAS
© 2008 National Committee for Quality Assurance
Innovation in Multicultural Health CareNCQA’s Awards Program
• Ample documentation of disparities, language and cultural needs
• Evidence base for improving disparities/addressing cultural competence is limited– Generic and targeted quality improvement activities reduce
disparities– Language services: increase overall quality; improve patient
understanding, medication use, and safety; reduce unnecessary ER utilization
– Cultural competency training improves physician self-rated knowledge
• What works best? What are Health Plans doing to reduce disparities and address CLAS?
© 2008 National Committee for Quality Assurance
Innovation in Multicultural Health Care Awards for Health Plans
• Objectives – Identify and recognize innovative
practices in health plans – Provide transferable models for
adoption and dissemination– Add to the evidence base about
effective methods for addressing CLAS/disparities
• Funded by The California Endowment
© 2008 National Committee for Quality Assurance
Awards Evaluation Criteria
• Strong program design, evidence-based intervention
• Innovative/creative• Impact on services & outcomes• Sustainable• Transferable• Organizational integration & leadership
© 2008 National Committee for Quality Assurance
Characteristics of Award Winning Initiatives
2006
2007
2008
Product Line
CommercialMedicaidMedicare
684
75
5
343
Region NationalMidwestNortheastSouthWestMultiple Regions
231031
413010
113101
Target Population
DoctorsPatientsCommunity
093
685
180
Focus Health Care DisparityLanguageCultural Competence
642
52 2
522
© 2008 National Committee for Quality Assurance
Health Plan Award Winners2006 2007 2008
Aetna Aetna Aetna
Blue Cross of California State Sponsored Business
Chinese Community Health Plan
Highmark, Inc.
CareFirst BlueCross BlueShield, Maryland
CIGNAKeystone Mercy Health Plan
Chinese Community Health Plan
Excellus Health Plan Molina Healthcare of MI
Health Net of CaliforniaHarvard Pilgrim Health Care
UnitedHealthcare Latino Health Solutions
HealthPartners Health Alliance Plan UnitedHealthcare
Kaiser Permanente Kaiser PermanenteVirginia Premier Health Plan, Inc.
Keystone Mercy Health Plan, PA
UnitedHealthcare Wellpoint, Inc.
L.A. Care Health Plan UPMC For You
Molina Healthcare of MI
© 2008 National Committee for Quality Assurance
FOR MORE INFORMATION:www.ncqa.org/clas.aspx
• NCQA’s Innovative Practices Report details award-winning initiatives
• Information from 2006, 2007 & 2008 winners
© 2008 National Committee for Quality Assurance
For More Information:
www.ncqa.org/clas.aspx
Esther S. HanSenior Health Care Analyst, Research