Aetna Life Insurance Company and its HMO Affiliates PDF | HTML
Breast cancer research has shown that African American and Hispanic women are more likely to have never undergone screening and thus have their first mammogram as the result of a physical exam finding or breast symptom. To address this issue, Aetna Women’s Health Department created the Breast Health Ethnic Disparity Initiative (BHEDI) in 2003 which aimed to increase yearly mammography rates within the self-identified African American/Black and Hispanic/Latina membership. This was done by providing culturally and linguistically appropriate information, tools and support, encouraging members to get recommended mammograms. A randomized control study was conducted to test the effectiveness of different program outreach methods against a control group. Since 2003, the program has continued to grow and improve through such testing, self-evaluation, refinement, and exploration of additional opportunities to increase screening rates. Among the first health plans to capture self-reported race/ethnicity and language preference data, Aetna has used this data to conduct targeted outreach and interventions. Since the BHEDI’s inception in 2003, screening rates for African American women who had not previously had a mammogram have more than doubled.
Contact: Karin Rush-Monroe, 215-775-2132
Chinese Community Health Plan (San Francisco) PDF | HTML
Although already the 5th leading cause of illness and death in the Chinese community, diabetes diagnoses have been increasing within the monolingual Chinese community. To overcome the lack of culturally and linguistically sensitive programs in addressing the health education and health care needs of the community, the Chinese Community Health Plan developed Diabetes Self-Management – a Cultural Approach. Through its low-tech/high-socialization format, the intervention addresses the immigrant population at multiple levels through a multidisciplinary approach. Program participants were enrolled in 12 support sessions, 1.5 hours in length, twice a month. Topics covered ranged from medication to stress management. Three HbA1c tests were included – at the beginning, middle, and end of the program. The program’s successes include a 2 percentage point reduction in HbA1c as well as positive evaluation from participants: Nearly 96% reported an increase in knowledge, 83% were able to better manage their diabetes, 78% gained emotional support, and 52% received the opportunity to gather with other diabetic patients. The program has been continued and there is a waiting list of people who wish to join the group.
Contact: Yolanda Lee, 415-955-8800 x3253
CIGNA PDF | HTML
Although one in four adults suffers from mental illness, only one in three Americans with mental illness seek care. According to the 2001 report Mental Health: Culture, Race, Ethnicity Supplement to the Mental Health Report of the Surgeon General (SMA-01-3613), the percentage of African Americans receiving needed care is only half that of non-Hispanic Whites. Among Hispanic Americans with a mental disorder, less than ten percent contact a mental health specialist, while fewer than one in five contact a general health care provider for assistance. To address the needs of their large Hispanic and African American membership as well as the need for culturally and linguistically appropriate support for accessing behavioral care, CIGNA greatly expanded the number of behavioral health practitioners available in various ethnic groups and moved to an open access model of care, allowing members to go directly to any network practitioner for routine outpatient behavioral care without prior authorization. CIGNA also provided a searchable provider directory enabling members to search for a practitioner by language spoken, gender, ethnicity, age treated, and clinical specialty and see practitioner photographs and self-descriptions of their practice. The number of Spanish-speaking practitioners was increased by nearly 84% and member satisfaction increased significantly between 2004 and 2006.
Contact: Mark Slitt, 860-226-2092
Excellus Health Plan (New York) PDF | HTML
Within Excellus’s Medicaid member population, Neonatal Intensive Care Unit (NICU) admission rates are higher for African American teens compared to the Caucasian teen population. The costs of such admissions are significant both in terms of financial and developmental repercussions. In light of this, Excellus Health Plan initiated a program which gave pregnant African American teens face-to-face contact with outreach workers with common cultural background and experience. Through social risk and substance use assessments, regular home visits, and the development and implementation of unique care plans, the initiative addressed the individual care needs of each participating member. Additionally, Excellus gave providers incentives to complete a prenatal registration form which facilitated risk stratification and initiated outreach. Focus groups were also conducted, providing a framework for quality improvement. The results of this initiative were twofold: NICU admissions decreased and Excellus saw a large return on investment. Admissions rates for African American teens decreased from 17.2% to 15.2% in 2004 and in 2006, rates continued to decrease down to 12.9%. In 2004, relative to all other ethnicities combined, African Americans were 3.75 times more likely to have a NICU admission. In 2005, this ratio dropped to 2.08 and in 2006, it dropped to 1.92.
Contact: Jim Redmond, 585-238-4579
Harvard Pilgrim Health Care (Massachusetts, Maine, New Hampshire) PDF | HTML
Although colorectal cancer is a leading cause of cancer morbidity among racial/ethnic groups, is it curable when detected early. To improve screening rates, Harvard Pilgrim initiated an interactive speech recognition telephone technology as a means to institute preventative screening reminders and educate members about colorectal screening. By depersonalizing such conversations, members reported feeling less threatened and embarrassed when discussing sensitive subject matter with the speech recognition software. Members interact with the technology using only their voice, eliminating the need for advanced technical skills on their end. This initiative has resulted in consistent improvements in screening rates since 2004 and through a geo-coding and surname analysis, a reduction in disparities has been shown among Hispanic/Latino members. The overall results of this initiative show screening rates have exceeded NCQA’s HEDIS 2006 national 90th percentile benchmark. Furthermore, 2006 data show the disparity in rates between their lowest (Hispanic/Latino) and highest (Blacks and African-Americans) racial/ethnic groups has been reduced.
Contact: Sharon Torgerson, 617-509-7458
Health Alliance Plan (Michigan) PDF | HTML
After data analysis revealed a disparity in breast cancer screening between African American and Caucasian females in the Henry Ford Medical Group, the Health Alliance Plan set out to reduce the gap. To do this, they conducted a barrier analysis with the target population, and implemented multiple outreach methods. These included brochures, outbound calls, a mammogram walk-in clinic, and incentives. A dinner/workshop was held for providers to raise awareness and share best practices. With this initiative, Health Alliance Plan established important collaboration with a large employer group and identified significant disparities in care. In addition to increased screening for African American women in the target group, the disparities that were initially present were eliminated.
Contact: Tiffany Baker, 248-443-1072
Kaiser Foundation Health Plan, Inc. PDF | HTML
Recognizing the lack of translated materials as well as the unverified quality of those materials that were available, Kaiser Permanente implemented the National Standardized Quality Translation Initiative. In this initiative, Kaiser proactively addressed its clinical demand for translated materials by implementing translation projects and retrospectively analyzed and assessed these materials to inform recommendations for quality improvement. These activities were conducted simultaneously in order to meet member needs in the absence of industry standards or benchmarks for translated materials in health care. Through this work, Kaiser Permanente standardized a quality translation process and infrastructure and created a centralized repository of translated information in order to create a virtual translation management environment. In this virtual environment, the standardized translation process can potentially be made broadly accessible, facilitating universal access to all Kaiser Permanente regions as well as external health care organizations and public institutions. As a result of their efforts, Kaiser Permanente has also developed and disseminated Health Care Glossaries in six languages: Spanish, Chinese, Vietnamese, Korean, Armenian, and Russian, providing standard translations of difficult-to-translate health care terms and phrases.
Contact: Gayle Tang, 510-271-6828
UnitedHealthcare PDF | HTML
Compared to other ethnic minority groups, Asian Americans report the lowest percentage of patients who feel that their physician understands their background and values. To address these concerns as well as the language discordance that affects many Asian American patients, UnitedHealthcare developed the Asian In-Language Provider Directory, listing the ethnic backgrounds and language abilities of providers and office staff. Through this initiative, they sought to provide better access by expanding their network and giving Asian American members the tools to identify linguistically- and ethnically-concordant network providers. The directory is available on-line as well as in hard-copy. 900 Asian providers were added to the network in the Los Angeles HMO market alone. Since the tool’s introduction, about 91,250 in-language users have accessed the provider directories to find their preferred providers.
Contact: Dan Miller, 714-226-3726
UPMC Health Plan (Pennsylvania) PDF | HTML
After an analysis of its membership, UPMC for You found that pregnant African American members of a specific community had generally poorer birth outcomes compared to other pregnant members in that area as well as those residing in other communities. UPMC analyses revealed disparities in multiple measures of maternal care including Timeliness of Prenatal Care and Post Partum Care. Among the various causes leading to poor birth outcomes, UPMC for You identified poor access to and use of prenatal care as well as psycho-social and environmental risks as key factors to address during the early stages of pregnancy. This initiative aimed to address these problems through the development of a new care-management model incorporating in-house maternity program staff, community agency representatives, community providers, providers and social workers from UPMC health centers, and trained community resident ambassadors. The model focuses on increased community awareness of the importance of prenatal care, earlier identification of pregnant women, identification of psychosocial and environmental risk factors, risk stratification of members, outreach, education and coordination of care to help members obtain necessary services. The model also includes the provision of a new service – Doulas trained to attend to and support the physical, emotional, and social needs of women during their pregnancy, labor and postpartum period. Not only has this program heightened community awareness and involvement, it has also increased program enrollment of African American women in the targeted community and decreased low birth-weight babies and preterm deliveries.
Contact: Michael Taylor, 412-454-7534