1 Addressing Racial & Ethnic Disparities in Health Care AHRQ 2007 Annual Conference September 28, 2007

2 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

3 Participation in the National Health Plan Collaborative: Phase I and Phase II

4 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

5 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 II Health plans focus on: Primary data collection Improving language access Determination of the business case and ROI for disparity reduction

6 NHPC: How health plans can achieve success in addressing disparities Community & Member Engagement Q.I. Infrastructure IT Infrastructure Provider Engagement Leadership Public- Private Partner- ships Corporate/Bus iness Case Alignment Learning Collaborative

7 Our Efforts: Information Sharing DATA STRATEGIES MEMBER & PROVIDER STRATEGIES COMMUNITY PARTNERSHIPS & GRANTS ORGANIZATIONAL COLLABORATION

8 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:

9 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.

10 Voluntary Data Collection All Lines of Business “Opt out” Option Self-Identified Voluntary Confidential Data Use: QI Race Ethnicity Language 2006

11 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).

12 Organizational and Community Strategies Health Care Disparities / Culturally Appropriate Linguistic Services Committee created in 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.

13 Other Current Activities Case ManagementExploring opportunities for Culturally tailored outreach CommunityAcademia, others Partnerships External Funding Applied for RWJF grant with RAND

14 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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16 Highmark in Motion