It has been ten years since the Institute of Medicine released its pivotal report, Unequal Treatment, presenting undeniable evidence of the existence of healthcare disparities, but our nation has yet to make significant headway to “close the gap.”
According to the 2011 National Healthcare Disparities Report, despite most screening measures showing improvement over time (e.g., mammography), racial/ethnic healthcare disparities have largely stayed the same or worsened over time (e.g., the Black- White gap in rates of advanced stage breast cancer has widened). Though quality of overall healthcare is improving, it is also well documented that minority populations — racial/ethnic, socioeconomic — on average continue to receive lower quality healthcare and suffer from higher rates of potentially avoidable complications compared to the general population. Most of these healthcare disparities have persisted over time and some are getting worse.
During the past few years, Blue Cross and Blue Shield Companies have made great strides to address healthcare quality. Millions of lives have been saved through Blue national efforts, including IHI’s 5 Million Lives campaign and the Joint Commission’s Center for Transforming Care (both funded by The Blues®), support for the CMMI Partnership for Patients and promotion of the Blue Surgical Safety Checklist. All of these initiatives seek to improve healthcare quality, patient safety and issues related to healthcare equity. Blue Cross and Blue Shield Companies are committed to assisting national and local champions of quality, safety and equity and will continue to work tirelessly to engage leadership to take action to find solutions.
The Blues continue, proactively, to seek out best practices and to facilitate sharing across Blue Companies, a few of which are highlighted in this document. Many efforts are led at the local level within communities and center around reducing healthcare disparities through the voluntary collection of race, ethnicity and primary language (REL) data, providing cultural competency training to employees and healthcare providers, as well as conducting local outreach activities tailored to specific population needs. Local Blue Plans’ activity across the nation is creating a strong network of patient-centered models for the equitable delivery of quality healthcare.
Highmark Blue Cross Blue Shield Collection and Use of REL Data to Reduce Diabetes Healthcare Disparities
A strong movement among Blue Companies across the nation promotes voluntary collection of race, ethnicity and primary language (REL) data to target high risk members in a culturally tailored way.
Highmark Blue Cross and Blue Shield has collected REL data on its membership since 2006, initially using a mailed survey approach with transition of direct data collection to Highmark’s member website in 2011. Highmark Blue Cross and Blue Shield analyzed HEDIS® data by REL to identify disparities and implemented interventions to close these gaps.
Intervention
In response to a disparity identified in A1C and LDL testing among Highmark’s African American members with diabetes, an educational mailing was sent to 331 members in the commercial and Medicare products, including the Special Needs Program (SNP) in Pennsylvania and West Virginia.
The mailing included a letter, self-management information, digital video and a response card designed to assess the member’s experience with the information.
Results
Within six months of the mailings, A1C and LDL testing for African American members with diabetes improved by 23.2 percent. Additionally, about 19 percent of members who did not show improved testing within six months agreed to enroll in a disease management program when contacted by a health coach. Of the returned response cards, 80 percent expressed interest in receiving additional materials from Highmark and Highmark’s case managers offered their assistance.
Anthem Blue Cross Blue Shield Training and Development Cultural Competency Promotion
Adapting to an increasingly diverse marketplace demonstrates the need to raise awareness among all employees and provider groups about the importance of cultural competency.
Training and tools are available for Anthem Blue Cross Blue Shield (Anthem) employees and contracted providers to improve cultural competency skills.
Intervention
Anthem currently has licenses for cultural competency training by Quality Interactions©, requires its employed nurses and physicians to complete the course, and is considering an enterprise-wide baseline cultural competency training program for all of its associates.
In addition, Anthem has invested and supported the development of new training from Critical Measures, LLC that examines the issue of medical disparities that result from globally mobile
populations. This new course, called Viewpoints, focuses on patient-centered medical interview skills that clinicians must have in order to be clinically competent in a globally mobile world. This course is scheduled to launch at the end of 2012 through Critical Measures, LLC.
Results
In the past four years, 107 doctors, 3210 nurses and 540 case managers have completed the Quality Interactions© training with statistically significant improvement of on average 48 points, out of a possible 100, as determined through pre and post testing.
Blue Cross and Blue Shield of Michigan Let's Talk Health Community Outreach
Blue Plan involvement in local communities ranges from providing charitable contributions to being actively involved in extending care services. Particularly important for addressing healthcare disparities is understanding how to collaborate with the community to support patients outside of clinical encounters.
Seeking community input on how Blue Cross and Blue Shield of Michigan (BCBSM) can collaborate better with community partners to meet community healthcare needs and planning a course of action around expressed concerns, experiences and ideas to improve community health status is the goal of BCBSM’s newest successful signature program, BCBSM Let’s Talk Health.
Intervention
BCBSM’s community initiative, Let’s Talk Health, is held in communities throughout Michigan.
Community leaders and residents are brought together to engage in dialogue about health issues and community concerns. Following the discussion, BCBSM creates a report so community members can see the results of their efforts and partnership opportunities for future development.
Results
Let’s Talk Health discussions have taken place in Arab/Chaldean, African American and Latino communities, engaging nearly 500 people in face-to-face dialogue. Participants included healthcare professionals, pastors, elected officials, grassroots leaders, concerned citizens, human services workers and business leaders. These discussions explored and identified potential opportunities for collaborative efforts that will reduce healthcare disparities, increase access to care, promote physical activity, and stress the importance of good nutrition and preventive care. BCBSM and local nonprofit partners are continuing to host community conversations in targeted neighborhoods around the state.
