QUALITY OF CARE FOR AFRICAN AMERICANS – AS WELL AS ASIANS AND HISPANICS – ARE FOCUS OF HEALTH PLAN INNOVATIONS

NCQA Annual Award Recognizes Bold Efforts To Solve Health Care Disparities Resulting From Cultural And Language Barriers

WASHINGTON–The National Committee for Quality Assurance (NCQA), with support from The California Endowment, has recognized eight managed care plans for innovative programs aimed at improving health care for African Americans, Hispanics, Asians and other ethnic groups.

Five recipients of the 2008 “Recognizing Innovation in Multicultural Health Care” Awards developed solutions specifically designed for African Americans in communities where, compared to the general population, they experience shorter life spans, higher rates of hypertension, significantly lower rates of breastfeeding, higher rates of disability and disease, and less use of a successful community-based fitness program.

Two other winning programs focused on overcoming language barriers to obtaining optimal health care services.  The final award went to a program that included identification of health disparity geographic “hot spots” by indirectly deriving accurate race and ethnicity information of its members.

Numerous studies have found that ethnic and racial minorities often receive lower quality health care than Caucasian patients, even when such factors as medical conditions, insurance and economic status are equivalent. Disparities range across the full spectrum of health services – from prenatal care to the quality of care received at the end of life.

Many African Americans are disproportionately affected by disease and other health conditions.  For example, according to the Centers for Disease Control and Prevention, compared to Caucasians, infant mortality among African Americans is twice as high, the cancer rate is 25% higher, and the mortality rate for diabetes is double .

“The gaps in care that persist for minorities and for non-English-speakers result in serious consequences: unnecessary disability and premature death for thousands,” said NCQA President Margaret E. O’Kane. “Any national health care reform effort must address these disparities.”

According to O’Kane, the efforts of awardees to promote cultural and linguistic competence and eliminate disparities are essential for creating a fair and equitable health care system and moving the U.S. from last on a list of 19 countries ranked for health care quality by the Commonwealth Fund.

The significance of health disparities is underscored by data from the Census Bureau that shows that approximately 1 in 8 Americans were born in another country and 52 million Americans speak a language other than English at home.

“Health care providers must be cognizant of their responsibility to provide care that is responsive to the needs of all Californians – regardless of race, ethnicity and language proficiency,” said Robert K. Ross, M.D., president and CEO of The California Endowment. “These awardees demonstrate that it is possible to move beyond a one-size-fits-all approach to health care delivery.”

Winners of the 2008 “Recognizing Innovation in Multicultural Health Care Award”:

• Aetna – African Americans’ higher prevalence of hypertension led to development of a Culturally Competent Disease Management Program (CCDMP) that included educational mailing kits and personalized outreach from disease management nurses for participants, and quarterly reports for the patients’ primary care physicians. Compared to a control group receiving a lightly managed program without a cultural focus, CCDMP members had a higher percentage of members with clinically acceptable blood pressures and there was an increase in blood pressure monitoring and medication usage.
• Highmark Inc. (Pennsylvania) – A partnership with SilverSneakers® Fitness Program included fitness memberships as part of the total benefit coverage to empower Medicare Advantage members to adopt a regular fitness routine. However, African Americans’ participation was far lower than that of Caucasians. Through neighborhood gap analysis, enhanced marketing materials, targeted staff training and community outreach, Highmark saw participation increase from 3.4 % to 18 % in four years, exceeding that of white members.
• Keystone Mercy Health Plan (Pennsylvania) – African American women experience more preventable disease and disability than non-minorities. “The Health Ministry Program's 40-Day Journey",” a community- and faith-based wellness program, offered participants access to health screenings, healthy eating education, stress management, and even Gospel aerobics. Participants lost weight, improved their mobility and flexibility, and lowered their heart rate and blood pressure.
• Molina Healthcare of Michigan – In 2006, only 7% of African American males in Detroit received preventive health exams.  The “Check Up or Check Out!” program was designed to address the underutilization of preventive health care services among black males.  Through personal outreach, education and incentives, preventive exam rates increased from 7% to 19% while testing rates for cholesterol, glucose, colorectal and prostate cancer doubled. 
• UnitedHealthcare  (New York) – Chinese-speaking seniors (including those eligible for Medicaid and Medicare services) were disenrolling as a result of cultural and linguistic barriers. Oxford Health Plan developed in-language walk-in centers to help seniors apply for Medicaid and other social service and community health programs. As a result, more members received benefits and disenrollment was halved.
• UnitedHealthcare Latino Health Solutions – An “Enhanced Bilingual Service and Member Access Initiative” was designed to improve Spanish-speaking members’ interactions with the plan. Through cultural training and phone routing to Spanish speaking customer care professionals (CCPs), satisfaction among members using CCPs increased from 65% to 90%.
• Virginia Premier Health Plan, Inc.  – African American women members were half as likely to breastfeed as white members before initiation of a breastfeeding collaboration with the Virginia Department of Medical Assistance Services and other community agencies. Through education and support – such as classes, hotlines, peer support groups, lactation consultants and free breast pumps – breastfeeding rates increased from 22% to 51%.
• Wellpoint, Inc. – To overcome a lack of self-reported race and ethnicity membership information, a means to indirectly derive information was developed with support from RAND Corporation. The resulting data enabled comparison of health plan performance by race and ethnic group. Overlaying the performance data with geographic software produced maps showing health disparity “hotspots,” supporting planning for improved service and access.

More information is available on each of these programs at www.ncqa.org/clas.aspx

NCQA’s program is funded by The California Endowment and is supported by the Centers for Medicare & Medicaid Services and The Office of Minority Health.

Health plans will receive their awards at a dinner on Sept. 18, in San Francisco, Calif., sponsored by Eli Lilly and Daiichi Sankyo, with additional support from Bristol Myers Squibb, and Novartis Pharmaceuticals Corporation. Health plans will also showcase their award winning initiatives at a poster session and reception preceding the award ceremony.

NCQA is a private, non-profit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes physicians in key clinical areas. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care.  NCQA is committed to providing health care quality information through the Web, media and data licensing agreements in order to help consumers, employers and others make more informed health care choices. For more information, visit www.ncqa.org.

The California Endowment, a private, statewide health foundation, was established in 1996 to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians.  For more information, visit http://www.calendow.org/.

Health plan contacts:

Aetna: Wendy Morphew, morphewWS@aetna.com, 212-457-0320
Highmark: Kimberly Scanish, kimberly.scanish@highmark.com, 717-302-4244
Keystone: Tonya Moody, tonya.moody@kmhp.com, 215-863-5700
Molina: Sunny Yu, sunny.yu@MolinaHealthCare.com, 562-901-1039
United: Dan Miller, dan.miller@phs.com, 714-226-3726
Virginia: Pamela Lepley, pdlepley@vcu.edu, 804-828-6057
Wellpoint: Jill Becher, jill.becher@wellpoint.com, 262-523-4764

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