Is end in sight on disparities?
Care, pay changes linked to cutting disparities
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.