Reducing Racial and Ethnic Disparities in
Managed Care
Constance Martin
Program Officer
AcademyHealth Annual Research Conference
June 25-28, 2006
for
CHCS Center
Health Care Strategies, Inc.
Disparities Initiatives
• Medicaid Managed Care Disparities
Collaborative
– State Purchasing Institute
– Health Plan QI Workgroup
• National Health Plan Collaborative
Racial and Ethnic Disparities Reduction in
Medicaid
• BCAP - Working with “early adopting”
Medicaid MCOs and their state and
provider partners to develop best practices
in reducing racial and ethnic disparities.
• Purchasing Institute – Provide states with
support in racial/ethnic data collection and
using this information to target quality
improvements.
Disparities Health Plan Workgroup
Health Plans
Target Issues
– Blue Cross of California
– Birth Outcomes
– Healthfirst (NY)
– Adolescent and Child Immunizations
– Helix Family Choice (MD)
– LA Care Health Plan (CA)
– Medica of Minnesota
– Asthma Care
– Diabetes Care
– Molina Healthcare of Michigan
– Monroe Plan for Medical Care (NY)
– Neighborhood Health Plan of Rhode
Island
– Network Health (MA)
– SoonerCare (OK)
– UPMC Health Plan (PA)
– Oregon Collaborative
TOTAL MEDICAID/SCHIP
ENROLLEES = 3,191,895
Stories to Share: Addressing
Disparities in Asthma Care
Blue Cross of California
• AIM: Increase the rate of asthma pharmacy consultations
among eligible African-American members with asthma
from 45 percent at baseline to within five percentage
points of the rate for Caucasian, non-Latino members with
asthma.
• ACTIVITIES:
– Targeted 8 pharmacies for education and intervention.
– Added second screen to identify reason for missed
opportunity.
– Established pharmacy report of asthma consults as
percent of eligibles by pharmacy by ethnicity.
Stories to Share: Addressing
Disparities in Asthma Care
Blue Cross of California
• RESULTS
–The rate of asthma consultations for AA
members increased from 44% to 51%.
–The disparity decreased from 8% at
baseline to 6% at last measurement.
Stories to Share: Addressing
Disparities in Birth Outcomes
Monroe Plan for Medical Care
• AIM: Reduce the Difference in NICU Admission
Rates between African-American Teens and
White Teens by 50%
• ACTIVITIES:
– Expansion of Healthy Beginnings Program with Focus
on African-American Teens with Social Outreach
(BabyLove) .
– Outreach Worker Readily Relating to Target
Population: Ethnicity, Experience, Her Own Success.
Stories to Share: Addressing
Disparities in Birth Outcomes
Monroe Plan for Medical Care
• Demonstrated Decrease in NICU Admission Rate
for All African American Teens from 18.1% to
13.5%
NICU Admission Rates for Teens
18.1
20
10
11
7.1
8.6
13.5
4.9
0
2004
White
2005
African-American
Difference
National Health Plan Collaborative
Health Plans
• AETNA
Target Issue:
– Diabetes Care
• CIGNA
• Harvard Pilgrim Health Care
• HealthPartners
• Highmark Inc.
• Kaiser Permanente
• Molina Healthcare
• UnitedHealth Group
• WellPoint, Inc.
TOTAL ENROLLEES =
76,748,227
Stories to Share: Addressing
Disparities in Diabetes Care
Kaiser Permanente
• Aim: Within selected Hispanic and African American
populations, increase performance on the following
outcome measures by 10%: 1) Proportion with good
HgA1c control and 2) Proportion adhering to A.L.L.
regimen.
• Activities:
– Partner with Kaiser Latino Center of Excellence in Colorado
which has bilingual and bicultural staff and providers
– Coordination and ownership of the activity across multiple
intra-organizational stakeholders
• Results
– Pending
Stories to Share: Addressing
Disparities in Diabetes Care
United Healthcare
• Aim: To improve diabetes care for Hispanic and African
American members in targeted regions as measured by HbA1c,
lipid control, BP control, eye exam, and foot exam rates.
• Activities:
– DocSite, web based patient registry at targeted physician
offices.
– Enrollment into appropriate disease management programs.
– Implement community wide initiatives in target regions (FL,
OH, KY, KS).
• Results:
– Pending