1. Improving Health Care, Improving Lives: 2007 AHRQ Annual Conference Systems-Level Approaches to Reducing Racial, Ethnic and Income Disparities in Healthcare Quality Frederick P. Cerise, M.D., M.P.H Vice President Health Affairs and Medical Education Louisiana State University System September 28, 2007

2. Percent of Medicaid Eligibles and Louisiana Population, by Race Medicaid Eligibles Louisiana Population African- American African- American White Other SOURCE: DHH data as of 8/31/2007; LA population est. 2005.

6. Two Approaches Systems-level intervention targeted to providers with lower performance on selected measures Establish expectations of all providers to be eligible to participate in Medicaid

7. Targeted Intervention 75 “bottom left” provider –Control: providers were mailed baseline indicator levels –Education only: providers were mailed baseline levels and nurse educators visited providers –Education + Reminder System: providers were mailed baseline levels, nurse educators visited providers, and providers had access to the reminder system All analyses are “intention to treat”

8. ! Reminder

9. CONTROL over time, p = 0.000 EDUCATION over time, p = 0.000 EDUC+SYS over time, p = 0.000 EDUC vs CONT, p = 0.652 EDUC+SYS vs CONT, p = 0.041 EDUC vs EDUC+SYS, p = 0.017 These p-values are from tests comparing baseline to follow-up changes between pairs of groups These p-values are from tests comparing baseline to follow-up levels within each group

10. CONTROL over time, p = 0.005 EDUCATION over time, p = 0.006 EDUC+SYS over time, p = 0.000 EDUC vs CONT, p = 0.806 EDUC+SYS vs CONT, p = 0.341 EDUC vs EDUC+SYS, p = 0.224

11. CONTROL over time, p = 0.000 EDUCATION over time, p = 0.000 EDUC+SYS over time, p = 0.000 EDUC vs CONT, p = 0.161 EDUC+SYS vs CONT, p = 0.199 EDUC vs EDUC+SYS, p = 0.027

12. Conclusion African Americans and low income patients are disproportionately represented among Medicaid recipients. There is great variation in performance among practices caring for Medicaid recipients. Practices with more patients tend to have higher compliance with standards. Systems level interventions can improve outcomes for Whites and African Americans. Despite improvements, some disparities remain.

13. Provider Expectations Establish new expectations for Medicaid expansion Expectations track NCQA Physician Practice Connections

14. Medicaid Expansion Expectations for primary care providers –Access and communications –Patient tracking and registry –Care management –Patient self management support –Electronic prescribing –Test tracking –Referral tracking –Performance reporting and improvement –Interoperability

15. Questions?