Disparities Initiatives
Reducing Racial and Ethnic Disparities in
Managed Care
• Medicaid Managed Care Disparities
Collaborative
– State Purchasing Institute
– Health Plan QI Workgroup
Constance Martin
• National Health Plan Collaborative
Program Officer
AcademyHealth Annual Research Conference
June 25-28, 2006
for
CHCS Center
Health Care Strategies, Inc.
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.
Disparities Health Plan Workgroup
Health
Health Plans
Plans
Target
Target Issues
Issues
–– Blue
Blue Cross
Cross of
of California
California
–– Birth
Birth Outcomes
Outcomes
–– Healthfirst
Healthfirst (NY)
(NY)
–– Adolescent
Adolescent and
and Child
Child Immunizations
Immunizations
–– Helix
Helix Family
Family Choice
Choice (MD)
(MD)
–– Asthma
Asthma Care
Care
–– LA
LA Care
Care Health
Health Plan
Plan (CA)
(CA)
–– Diabetes
Diabetes Care
Care
–– Medica
Medica of
of Minnesota
Minnesota
• Purchasing Institute – Provide states with
support in racial/ethnic data collection and
using this information to target quality
improvements.
–– Molina
Molina Healthcare
Healthcare of
of Michigan
Michigan
–– Monroe
Monroe Plan
Plan for
for Medical
Medical Care
Care (NY)
(NY)
–– Neighborhood
Neighborhood Health
Health Plan
Plan of
of Rhode
Rhode
Island
Island
–– Network
Network Health
Health (MA)
(MA)
TOTAL
TOTAL MEDICAID/SCHIP
MEDICAID/SCHIP
ENROLLEES
ENROLLEES == 3,191,895
3,191,895
–– SoonerCare
SoonerCare (OK)
(OK)
–– UPMC
UPMC Health
Health Plan
Plan (PA)
(PA)
–– Oregon
Oregon Collaborative
Collaborative
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.
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.
– Established pharmacy report of asthma consults as
percent of eligibles by pharmacy by ethnicity.
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Stories to Share: Addressing
Disparities in Birth Outcomes
Stories to Share: Addressing
Disparities in Birth Outcomes
Monroe Plan for Medical Care
Monroe Plan for Medical Care
• AIM: Reduce the Difference in NICU Admission
Rates between African-American Teens and
White Teens by 50%
• Demonstrated Decrease in NICU Admission Rate
for All African American Teens from 18.1% to
13.5%
NICU Admission Rates for Teens
• ACTIVITIES:
– Expansion of Healthy Beginnings Program with Focus
on African-American Teens with Social Outreach
(BabyLove) .
18.1
20
10
11
7.1
8.6
2004
White
Target
Target Issue:
Issue:
–– Diabetes
Diabetes Care
Care
•• CIGNA
CIGNA
•• Harvard
Harvard Pilgrim
Pilgrim Health
Health Care
Care
•• HealthPartners
HealthPartners
TOTAL
TOTAL ENROLLEES
ENROLLEES ==
76,748,227
76,748,227
2005
African-American
Difference
Stories to Share: Addressing
Disparities in Diabetes Care
National Health Plan Collaborative
•• AETNA
AETNA
4.9
0
– Outreach Worker Readily Relating to Target
Population: Ethnicity, Experience, Her Own Success.
Health
Health Plans
Plans
13.5
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:
•• Highmark
Highmark Inc.
•• Kaiser
Kaiser Permanente
Permanente
–– Partner
Partner with
with Kaiser
Kaiser Latino
Latino Center of Excellence in Colorado
which
which has
has bilingual
bilingual and
and bicultural
bicultural staff
staff and
and providers
providers
•• Molina
Molina Healthcare
–– Coordination
Coordination and ownership of the activity across multiple
intra-organizational
intra-organizational stakeholders
stakeholders
•• UnitedHealth
UnitedHealth Group
•• WellPoint,
WellPoint, Inc.
Inc.
• Results
–– Pending
Pending
Stories to Share: Addressing
Disparities in Diabetes Care
United
United Healthcare
Healthcare
•• Aim:
Aim: To
To improve
improve diabetes
diabetes care
care for
for Hispanic
Hispanic and
and African
African
American
American members
members in
in targeted
targeted regions
regions as
as measured
measured by
by HbA1c,
HbA1c,
lipid
lipid control,
control, BP
BP control,
control, eye
eye exam,
exam, and
and foot
foot exam
exam rates.
rates.
•• Activities:
Activities:
–– DocSite,
DocSite, web based patient registry at targeted physician
offices.
offices.
–– Enrollment
Enrollment into
into appropriate
appropriate disease
disease management
management programs.
programs.
–– Implement
Implement community wide initiatives in target regions
regions (FL,
(FL,
OH,
OH, KY,
KY, KS).
KS).
•• Results:
Results:
–– Pending
Pending
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