Using Indirect Methodology to Estimate
Race/Ethnicity for Proactive Outreach with
Culturally Relevant Strategies
2010 AcademyHealth Annual Research Meeting
June 27 -29, 2010
Z h
Zachary
Vernon
V
Sr Health Information Consultant
Zack.Vernon@WellPoint.com
Agenda
g
Overview of Proxy Methodologies
• Why use them?
• What are they?
• How accurate are they?
Using Individual Predicted Race / Ethnicity for Proactive
Outreach
• Can accuracy be improved by using thresholds?
• How would members react?
• Study Design
(C) Copyright 2010 -- WellPoint, Inc
2
WellPoint Inc.
Nation’s Largest Insurer
~34 million medical
members
1 out of 9 Americans are covered by
WellPoint’s affiliated health plans
Total Revenue
More than $
$60 billion
Provider Network Advantage
~94%
94% Hospitals
~82% Primary Physicians
~84% Specialists
Blue Licensee
14 states
Note: Provider Network refers to BlueCard® PPO Network
(C) Copyright 2010 -- WellPoint, Inc
3
Why
y Use Indirect Methodology
gy
• In order to identify and address health disparities, plans must have
race/ethnicity data
• Commercial plans often have limited race/ethnicity data on their enrollees
• Cost of additional data fields and collection
• Inaccurate data collection from external entities
• Internal fears of “bad PR”
• Plans actively collecting primary source data often encounter data collection
plateaus
• Benefits to using indirect methodology
• Low cost alternative to expense of collecting primary source data
• Fast to implement
• Filling in gaps in primary source data
 Allows analysis of members who do not respond to requests for self reporting
 Enables the analysis of selection bias among self reported responders
 Accurate Plan
Plan, Regional,
Regional and Practice level analysis is difficult when data gaps
exist
(C) Copyright 2010 -- WellPoint, Inc
4
What is Proxy
y Methodology
gy
• At WellPoint
WellPoint, we developed a statistical methodology that allows the
prediction of race/ethnicity for members of WellPoint’s affiliated
plans
• The methodology utilizes
• Enrollee first and last names
• Enrollee residential address
• First names are matched to an internally developed list of African
American first names
• Surnames
S
are matched
t h d to
t a series
i off surname list
li t from
f
the
th U.S.
US
Census
• Through geocoding, addresses are linked to Census data based
upon an enrollee’s neighborhood
• These factors are linked together using logistic regressions to
determine the probability that a person is Asian, African American,
Hispanic, or White/other
(C) Copyright 2010 -- WellPoint, Inc
5
Components of Indirect Methodology
Logistic Regression
• Combines name and location data
• Calculates probability that enrollee is White/Other, African
American, Asian, and Hispanic
M b
Member
White / Other
(%)
African American
(%)
Asian
(%)
Hispanic
(%)
A
72.5
7.4
7.7
12.4
B
3.6
0.5
2.0
93.8
C
42.4
54.7
0.9
2.0
Source: Internal WellPoint Analysis 2008
(C) Copyright 2010 -- WellPoint, Inc
6
Is Indirect Methodology Really Reliable?
Accuracy Rate – Population Aggregate
• Aggregate Data
• Indirect methods have high degree of accuracy when comparing
population groups
Source: Internal WellPoint Analysis 2008
(C) Copyright 2010 -- WellPoint, Inc
7
Is Indirect Methodology Really Reliable?
Accuracy Rate – Individual Member
Level
Individual analysis
Indirect methods show strong potential in identifying the R/E of
individual members (86.2% of the validation set identified correctly)
Individual R/E Correctly Predicted
Approach
N = 192
192,096
096
All Members
Accuracy Rate
Over 80% Accuracy Rate
Over 80%
Member
Count
Surname
74.5%
90.8%
130,150
Geocoding
62.9%
84.4%
54,092
Logistic Model
86.2%
93.8%
145,009
Individual Predictions – Positive Predictive Value
Approach
N = 192,096
Hispanic
Asian
African American
White / Other
Surname
84.4
90.2
79.7
54.3
Geocoding
76.4
52.0
58.6
49.5
Logistic Model
93.2
90.0
77.8
76.4
(C) Copyright 2010 -- WellPoint, Inc
8
Can marketing techniques be used to improve health?
Engaging Minority Members
• Many Industries use estimated Race / Ethnicity in marketing
• Targeted mailings
• Calls
• Diabetes Equities Pilot
• One of the first disease management programs to engage members directly
based on predicted race / ethnicity
• Utilized culturally relevant materials tailored for specific minority groups
(African Americans and Latinos)
• Minimizing member abrasion
•
•
•
•
•
Probability threshold set at 80% for race / ethnicity identification
Messaging developed with a goal of minimizing member abrasion
Introduction letter offering member opt out
Special staff training to deal with complaints
Encourage members to share with friends
(C) Copyright 2010 -- WellPoint, Inc
9
Can accuracy be improved by using thresholds?
Identifying Member Race / Ethnicity
By Setting Thresholds Accuracy Improves
Source: Internal WellPoint Analysis 2008
(C) Copyright 2010 -- WellPoint, Inc
10
Introduction for
African Americans
(C) Copyright 2010 -- WellPoint, Inc
11
Health Education Pieces that Deploy
Culturally Accepted Social Mediums
Fotonovela
Family Reunion Guide
(C) Copyright 2010 -- WellPoint, Inc
12
How would members respond?
Study Design
• Population Studied
• 6 Employer Groups
• 2 States – CA and GA
• Variety of industries
• Focus on commercially insured African American and Hispanic / Latino
diabetics
• 1,172 Estimated African Americans
• 873 Estimated Hispanic / Latinos
• Basis of Study
• Selected plan members mailed culturally relevant materials based on
estimated race / ethnicity
• Strong internal concerns about member abrasion
• Outcomes
• Only one member complained (White member identified as African American)
• Complaint successfully enrolled in disease management program
(C) Copyright 2010 -- WellPoint, Inc
13
For More Information on Culturally
Relevant Materials
Visit Grace Ting
Ting’s
s Poster:
Focus Group
p Findings:
g Themes of Motivational Drivers for
Culturally Relevant Strategies for Hispanics and African
Americans
Poster Session: C
Date: Monday, June 28
Ti
Time:
6:30
6 30 PM - 8:00
8 00 PM
Contact: Grace
Grace.Ting@WellPoint.com
Ting@WellPoint com
(C) Copyright 2010 -- WellPoint, Inc
14
Questions?
(C) Copyright 2010 -- WellPoint, Inc
15