Health Care :: National Health Plan Collaborative Enters Phase Two of Its Work to Improve the Quality of Health Care for All

Collaborative of major health plans now covers nearly half of all commercially insured Americans and millions served by Medicare and Medicaid.

The National Health Plan Collaborative, now made up of 10 major health plans, has announced its Phase Two goals for reducing racial and ethnic disparities in health care. As Phase Two kicks off, Humana is joining the Collaborative as its newest member. The Collaborative members now represent nearly half of commercially insured Americans and millions served by Medicare and Medicaid.

“Humana’s desire to join the Collaborative reflects the continued momentum behind this effort and the recognition that addressing racial and ethnic disparities is a growing imperative for health industry leaders,” said Stephen Somers, Ph.D., president of the Center for Health Care Strategies, which directs the Collaborative.

The other Collaborative members include Aetna, CIGNA, Harvard Pilgrim Health Care, HealthPartners, Highmark, Kaiser Permanente, Molina Healthcare, UnitedHealth Group and WellPoint.

Together, these 10 plans are testing and implementing pilot programs and methods to:

Collect racial, ethnic and language data to inform disparity-reduction efforts within their respective memberships.

Improve health care access and quality by enhancing language services for patients whose primary language is not English.

Support investments in disparities reduction by making a business case for addressing disparities.

“The Collaborative has set ambitious goals to improve the quality of health care for patients from specific racial and ethnic backgrounds who often experience lower-quality care; ultimately the interventions being tested will improve the quality of care received by all Americans,” said Carolyn Clancy, M.D., director of the Agency for Healthcare Research and Quality.

During Phase One of the Collaborative, plans conducted a number of pilot programs aimed at improving data collection and analysis to help plans identify and address disparities. Several plans also tested ways to reduce language-related barriers to quality care by targeting plan staff, providers and enrollees. Below are examples of the pilot interventions carried out by each plan:

Aetna: Based on self-identified race, ethnicity and language preference data provided by more than 5.2 million of its members, Aetna has implemented culturally appropriate disease management methods targeting members with diabetes. For example, Aetna’s blood glucose monitoring program uses Spanish-language services and materials to better serve and empower Spanish-speaking members with diabetes. In addition, the company began a breast health outreach program in 2002 which encourages yearly mammograms in Aetna’s African-American and Hispanic female members.

CIGNA: CIGNA has taken a multifaceted approach that aims to address gaps in care; collect race, ethnicity and language preference data; promote cultural competency among staff members; and ensure that member communications are linguistically appropriate and culturally sensitive. In addition, CIGNA promotes community interventions to improve access to health care.

Harvard Pilgrim Health Care: Harvard Pilgrim has implemented several interventions to evaluate and improve data collection, including the collection of data during computer-generated outreach calls. It has also started programs to reduce disparities faced by Hispanic patients with diabetes and to increase the rates of colorectal cancer screenings among Hispanic members.

HealthPartners: HealthPartners has been gathering race, country of origin, and language preference data voluntarily self-reported by patients and members at its clinics, hospital and through its Web site. HealthPartners is using this data to measure the quality of care and service it delivers across diverse patient and member groups, and to develop interventions to reduce disparities.

Highmark: To address data collection needs, Highmark sent members letters in two languages asking them to complete a confidential questionnaire on language preference and self-identified race and ethnicity. More than 30 percent of those surveyed responded, enabling Highmark to determine, in conjunction with other data, the appropriate language assistance services that should be made available, in addition to those services that are currently available.

Humana: Humana is working to establish baseline race, ethnicity and language data through primary and geo-coded data collection. Humana maintains language translation services for members, which provides full service language interpretation and translation over the phone with 150 languages available. A number of member educational materials are available in both English and Spanish. Members can identify providers who meet their language preference through the Humana web-based “Physician Finder” or by contacting a member service representative. In addition, Humana associates have available on-line cultural diversity courses through the company’s Diversity Resources Center, including Spanish-language tutorials.

Kaiser Permanente: With the goal of reducing cardiovascular mortality of diabetic patients by nearly 50 percent, Kaiser Permanente is developing a culturally appropriate outreach model for delivering a proven cardiovascular risk reduction program to its Latino members with diabetes.

Molina Healthcare: Molina Healthcare built upon success in reducing disparities through earlier work done with the Robert Wood Johnson Foundation. The plan’s fully bilingual, 24-hour Spanish nurse advice service was integrated with its disease management program, providing round-the-clock bilingual staff to help Spanish speaking members with asthma, diabetes and heart disease. Molina’s focus in Phase Two of the Collaborative will be to improve access and availability of translated materials and other language services for all Collaborative members.

UnitedHealth Group: UnitedHealth Group designed a pilot that uses a free Web-based patient registry providing disease-specific patient data, including patient-level race and ethnicity data, to help physicians manage patients with diabetes and cardiovascular disease.

WellPoint: WellPoint used and refined proxy methodology for estimating race/ethnicity data to identify disparity “hot zones” or “clusters.” It then implemented programs to send cultural competency toolkits to providers practicing in these highly disparate areas, and developed culturally and linguistically appropriate patient education materials. In Phase Two, WellPoint plans to use the methodology to assess member language needs and to enhance its disease management predictive modeling to better recruit minority members into its disease prevention and management programs.

“Through these pilot programs, plans are discovering effective ways to identify and reduce disparities,” said John Lumpkin, M.D., M.P.H., senior vice president and director of the Health Care Group at the Robert Wood Johnson Foundation. “We are excited about the progress that the Collaborative is making and confident that the plans are on track to make a difference in the quality of health care their members receive and to share solutions with other health plans.”

The Collaborative will now build on the lessons learned through the pilot interventions and will continue to develop tools and recommendations for use in addressing disparities in the quality of care.

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