Is end in sight on dis­par­i­ties?

Care, pay changes linked to cut­ting dis­par­i­ties

Modern Healthcare - - FRONT PAGE - Paul Barr

One year af­ter the launch of a health­care as­so­ci­a­tion-backed cam­paign tar­get­ing the elim­i­na­tion of health dis­par­i­ties, the in­dus­try may be en­ter­ing a prime po­si­tion to ac­tu­ally be­gin re­duc­ing dif­fer­ences of care be­tween ra­cial, eth­nic and other groups af­ter years of lim­ited suc­cess.

The key to the po­ten­tial for suc­cess in re­duc­ing dis­par­i­ties is not a re­sult of the cam­paign, Eq­uity of Care, but may be a prod­uct of the qual­ity im­prove­ment and re­im­burse­ment changes tak­ing place in the in­dus­try, which dove­tail with dis­par­ity re­duc­tion ef­forts, in­dus­try ex­ec­u­tives say.

“What’s good for (re­duc­ing) dis­par­i­ties is good for qual­ity of care for ev­ery­one in Amer­ica,” said Dr. Mar­shall Chin, di­rec­tor of a dis­par­i­ties-fo­cused pro­gram backed by the Robert Wood John­son Foun­da­tion and pro­fes­sor of medicine at Univer­sity of Chicago Medicine.

Ef­forts to im­prove the qual­ity of care and change fi­nan­cial in­cen­tives through such things as ac­count­able care or­ga­ni­za­tions and med­i­cal homes are a good con­duit for re­duc­ing health dis­par­i­ties—if ex­plic­itly in­cluded, said Chin, di­rec­tor of the pro­gram Find­ing An­swers: Dis­par­i­ties Re­search for Change. Hop­ing that a gen­eral qual­ity im­prove­ment pro­gram will re­duce dis­par­i­ties would be a mis­take, as health eq­uity must be an in­te­gral com­po­nent for dis­par­i­ties to be af­fected, he said.

Now could be a piv­otal time to try to do that as the in­dus­try moves to new pay­ment mod­els that re­ward hos­pi­tals for pro­vid­ing bet­ter qual­ity care. Hos­pi­tals likely are al­ready work­ing on qual­ity im­prove­ment pro­grams, so adding a dis­par­i­ties di­men­sion should not be dif­fi­cult, Chin said.

As a re­sult of that be­lief, qual­ity plays a big role in an out­line for in­dus­try par­tic­i­pants to re­duce dis­par­i­ties that was cre­ated by the Find­ing An­swers pro­gram, based at the Univer­sity of Chicago. The re­port, “A roadmap and best prac­tices for or­ga­ni­za­tions to re­duce ra­cial and eth­nic dis­par­i­ties in health care,” was pub­lished last week in the Jour­nal of Gen­eral In­ter­nal Medicine.

The roadmap in­cludes six steps to­ward re­duc­ing health dis­par­i­ties: rec­og­nize dis­par­i­ties and com­mit to re­duc­ing them; im­ple­ment a ba­sic qual­ity im­prove­ment struc­ture and process; make eq­uity an in­te­gral com­po­nent of qual­ity im­prove­ment ef­forts; de­sign the in­ter­ven­tion or in­ter­ven­tions; im­ple­ment, eval­u­ate and ad­just any in­ter­ven­tions; and take ac­tion to sus­tain them.

“We’re help­ing to fill a cur­rent gap in the field,” Chin said. The road map is based on 33 re­search projects and 12 sys­tem­atic lit­er­a­ture re­views con­ducted by the pro­gram. Chin said the roadmap is more broad and com­plete than ex­ist­ing ef­forts, such as the Eq­uity of Care cam­paign, which was launched about a year ago by the As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges, the Amer­i­can Col­lege of Health­care Ex­ec­u­tives, the Amer­i­can Hospi­tal As­so­ci­a­tion, the Catholic Health As­so­ci­a­tion and the Na­tional As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems (July 25, 2011, p. 10).

The Eq­uity of Care cam­paign is fo­cused on three im­por­tant mat­ters—data col­lec­tion, cul­tural com­pe­tency and gov­er­nance—but if the in­dus­try does only those things as part of its dis­par­i­ties re­duc­tion ef­fort, “that won’t be enough,” Chin said. Such pro­grams do, though, “cre­ate the cli­mate where you can take ac­tion,” he said.

Of­fi­cials for groups that started Eq­uity of Care said the cam­paign has done just that.

“We’ve cre­ated new en­ergy in the space,” said Marc Nivet, chief diver­sity of­fi­cer for the AAMC. “That, in and of it­self, is suc­cess,” he said. The cam­paign has helped raise aware­ness by post­ing about 100 case stud­ies on dis­par­i­ties re­duc­tion on its web­site and also is plan­ning a se­ries of we­bi­nars on ways to pro­mote health eq­uity at hos­pi­tals, med­i­cal schools or other health­care fa­cil­i­ties.

Nivet, like Chin, said gov­ern­ment-en­cour­aged qual­ity and re­im­burse­ment ef­forts em­a­nat­ing from the Pa­tient Pro­tec­tion and Af­ford­able Care Act could en­cour­age hos­pi­tals to step up their ef­forts to rid health­care of dis­par­i­ties among mi­nori­ties.

The ACA cre­ates more of a fi­nan­cial case for re­duc­ing dis­par­i­ties given the gov­ern­ment and pri­vate in­sur­ers’ ef­forts to im­prove qual­ity, of­fi­cials said. “Ini­tially, we ap­proached it as a moral im­per­a­tive, but now it’s also a busi­ness im­per­a­tive,” said John Blu­ford, pres­i­dent and CEO of Tru­man Med­i­cal Cen­ters, Kansas City, Mo., and im­me­di­ate past chair­man of the Amer­i­can Hospi­tal As­so­ci­a­tion.

Blu­ford said he ex­pects to see pos­i­tive re­sults from ex­ist­ing and fu­ture ef­forts to di­ver­sify hospi­tal boards. The AHA has a cam­paign to ed­u­cate po­ten­tial mi­nor­ity trus­tees that has ex­pe­ri­enced suc­cess. There have been about 15 mi­nori­ties placed on boards as a re­sult of the AHA ef­forts, and “I sus­pect over the next year and a half or so that that num­ber’s go­ing to quadru­ple,” Blu­ford said. Good diver­sity on a board leads to bet­ter de­ci­sions at the hospi­tal, he said.

Suc­cess of some type would be wel­come. An an­nual re­port tab­u­lat­ing dis­par­i­ties from the Agency for Health­care Re­search and Qual­ity showed that of the mea­sures used to track dis­par­i­ties, roughly half showed no im­prove­ment and 40% showed a de­cline from 2002 through 2008. Asians, Amer­i­can In­di­ans and Alaska Na­tives re­ceived worse care than whites for 30% of clin­i­cal qual­ity mea­sures in the re­port, and 41% of black pa­tients re­ceived worse care (April 30, 2012, p. 12).

The ef­fort to elim­i­nate dis­par­i­ties is in­creas­ingly in­clud­ing the les­bian, gay, bi­sex­ual and trans­gen­der pop­u­la­tion. The ACHE has made re­spect­ing sex­ual ori­en­ta­tion and gen­der iden- tifi­ca­tion part of its pro­mo­tion of diver­sity in the work­force and the re­duc­tion of health dis­par­i­ties. ACHE Pres­i­dent and CEO Thomas Dolan pub­lished an ed­i­to­rial on the sub­ject in the July/Au­gust is­sue of its mag­a­zine, and the ACHE plans to pro­duce a pol­icy state­ment to be con­sid­ered by its board in Novem­ber, said Deb­o­rah Bowen, ex­ec­u­tive vice pres­i­dent and chief oper­at­ing of­fi­cer.

The up­com­ing changes in health­care may aid ef­forts to elim­i­nate ra­cial dis­par­i­ties.

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