Measuring Health Indicators for Asian Women at the Organization Level Kathryn L. Coltin Asian Women’s Health Forum May 21, 2014

Organizations that Contributed Data – Health Plans Harvard Pilgrim Health Care Neighborhood Health Plan – Provider Groups/Practices South Cove Community Health Center Health Indicators Reported by at least 2 Organizations – Preventive care Chlamydia screening Cancer screenings – Breast Cancer – Cervical Cancer – Chronic care management Diabetes Monitoring – Blood sugar levels (HbA1c test) – Kidney function Asthma medication adherence Antidepressant medication adherence Health Indicators: Organization Level Measurement 2

Health Plan Rates – Based on: Medical claims: regardless of who delivered care or where received – All eligible members – Only care that is captured in claims – Only care received during period member was covered by health plan Medical record review: mainly PCP records; sometimes specialist records – Random sample of eligible members – Only care that is documented in record – Care delivered any time during measurement period Member surveys – Random sample of eligible members at a point in time – Only care that individuals are likely to recognize and remember – Care received any time during measurement period Provider Rates – Based on: Billing data – Services billed by that practice – All services billed for patients with a PCP in that practice (claims data from health plans) Medical records – Paper records for that practice : random sample of eligible patients – Electronic medical records for that practice: all eligible patients – Health information exchange: all eligible patients 3

Health Indicators: Organization Level Measurement Preventive care indicators: Self-report > Medical record > Claims – Bias toward over-report – Documentation failures – Data access Chronic care indicators: Self-report < Claims < Medical records – Unfamiliarity with tests or drugs – Recall of test values Comparing rates for population sub-groups – Reliability of data source depends on Completeness of data Size of eligible population Composition of eligible population (age, sex, race/ethnicity) – Most health plan indicators reported here are based on claims; some are hybrid – Provider indicators are based on electronic medical record data 4

PREVENTIVE CARE SCREENINGS Health Indicators for: 5

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CHRONIC CARE MANAGEMENT Health Indicators for: 13

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Health Indicators at the Organization Level: Summary of Findings Rates of preventive care screenings among Asian health plan members and health center patients are similar to those of other members/patients and higher than state and national rates. Rates of monitoring tests for diabetes among Asian health plan members are similar to those of other members and to state and national rates. Among Asian health plan members, medication adherence rates for both asthma controller drugs and antidepressants are lower than those of other health plan members and lower than state and national rates – Cultural and financial barriers may play a role in medication adherence and should be addressed 20

QUESTIONS? 21

22 “True” rate falls somewhere along the orange bar Length of orange bar (95% Confidence Interval) is affected by sample size (N)