Disparities Leadership Program: Implementation of Strategies to Address Disparities in Health Care

Transcription

1 Disparities Leadership Program: Implementation of Strategies to Address Disparities in Health Care The WellPoint Experience Diversity Rx Conference Baltimore, Maryland October 18, 2010 Grace H. Ting, MHA, CHIE Health Services Director, Programs in Clinical Excellence WellPoint, Inc. V

2 Change Is Difficult in Any Organization 2

3 About WellPoint WellPoint, Inc. One in nine Americans have coverage from a WellPoint affiliated health plan. ME WI NY NH MA CA NV CO MO IL IN KY OH VA CT States with a WellPoint affiliated health plan serving members as a Blue Cross and/or Blue Shield Association licensed plan TX GA Other states with > 100,000 members in other affiliated health plans 3

4 Katter's Change Continuum at WellPoint Katter's Eight-Stage Process of Creating Major Change Ongoing 1. Establish a sense of urgency House account analysis 2. Create a guiding coalition Executive sponsors 3. Develop a vision and strategy Pilot development 4. Communicate the change vision Pilot sponsorship/ DLP 5. Empower employees Pilot implementation 6. Generate short term wins Pilot evaluation 7. Consolidate gains for more change Expand on best practices 8. Anchor new approaches Institutionalize best practices Source: Adapted from John P. Kotter's Eight-Stage Process of Creating Major Change from Leading Change, Harvard Business School Press, Boston,

5 1. Addressing the Urgency Lesson #1 Start where you have data 1. WellPoint House Account Analysis in late 2005 Used associate race/ethnicity (R/E) data from HR database (available for 60% of associates) and matched with claims to perform analysis Major findings: R/E minorities spend more on reactive (inpatient) vs. preventative or proactive (outpatient & Rx) care Top 5 most disparate diagnoses for R/E minority WLP associates Pregnancy Complications Newborn Disorders Obesity Diabetes Asthma Health disparities among our R/E minority associates for just the top 5 disparate conditions cost WellPoint s house account $862,000* in * ($) estimated total annual incremental cost of health disparities, by condition, for 21,563 WellPoint associates with self-reported R/E data. 5

6 2. Create a guiding coalition Lesson #2 Promote data to secure executive and key stakeholder support 1. Launch of dedicated Health Disparities Analytic Unit Primary WellPoint strategy to use indirect R/E data Speed of implementation Lower cost alternative to updating IT systems for primary data collection Fill in gaps in primary source data Preliminary proxy estimates can support campaigns to collect primary source data Direct data collection in place Health risk appraisals Disease management programs State sponsored business 3 rd party data feeds Data on approx 1.3 million members collected to date 6

7 2. Create a guiding coalition, continued 2. Find executive leadership sponsors Chief Medical Officer EVP of Human Resources 3. Establish an advisory committee to address health disparities Includes Internal stakeholders Involves cross-cutting department across quality teams, disease management, human resources, legal, network management Meets monthly Reports to the Corporate Quality Oversight Committee 7

8 Applications of REL Data Brooklyn Mammography Rates: Analysis of Racial Composition by Zip R/E demographic data can be linked to quality data to examine performance of different groups Data can be reported on various levels State level Regional level Provider practice group Employer Group Decision support tools help identify areas of interest GIS applications facilitate visual drill down to community and individual hotspots Source: WellPoint HEDIS 2008 (2007 Data) and 2007 Claims Data 8

9 3. Develop a Vision and Strategy Top-Down Leadership Support But Limited Resources Typical model to start small with pilots then expand successful initiatives Varied geography creates different environments and different needs Initial strong interest in CA based on R/E diversity and political climate Interest in GA to address disparities in African Americans Focus on developing competency for addressing health disparities among disease management staff Market research to identify motivational drivers for health behavioral change among African Americans and Latinos. Findings included: African American and Latinos members motivational drivers are very different Despite inter- and intra-cultural differences, four key engagement drivers emerged among minority members, which should be a part of our communication strategy for minority members 9

10 4. Communicate the change vision: Disease Management Diabetes Health Equities Pilot In scope Member-level strategies to enhance engagement that can be replicated nationally on a large scale Commercial (private) medical insurance Out of scope Provider education (diabetes knowledge and patient-centered communication skills) Local or community-based initiatives Beginning with the end in mind How do culturally relevant strategies for African Americans and Latinos with diabetes impact member engagement and health outcomes (proximal, intermediate, and long-term)? WellPoint DLP Participation May 2008 to January

11 5. Empower employees: Disease Management Diabetes Health Equities Pilot 1. Clinical cultural competency training deployed to all employed physicians and nurses 2. Extensive stakeholder involvement in the developed of the pilot Over 200 associates involved on project work teams Much of the pilot member educational materials had to be developed in-house based on market research feedback Custom training about the health disparities and the pilot developed and deployed 3. WellPoint s proprietary indirect race/ethnicity predictive model used for direct member outreach DLP faculty and fellow-program participants provided feedback on: Strategy to build broad organizational support Member communications tips to decrease potential abrasion 11

12 6. Generate short term wins: Disease Management Diabetes Health Equities Pilot 1. Health Equities Pilot had vigorous evaluation plan Randomized control trial Data did show positive trends towards increased disease management program engagement among minority study group, although the difference was not statistically significant 2. Both the indirect methodology and pilot materials have been recognized with industry awards: Indirect data NCQA CLAS Award 2008, BlueWorks Award 2008 Pilot materials 2008 Bronze Web Health Award and Awards of Merit from the Health Information Resource Center, 2010 Best of Blues Clinical Distinction Award Numerous external presentations at national forums DLP faculty provided suggestions on pilot study evaluation plan. 12

13 7. Consolidate gains for more change: Disease Management Curriculum Enhancements 1. Expansion Health education pieces that study participants felt were the most useful Fotonovela, depression, fast food guide, recipe substitution guide Content enhanced and generalize to cover more health conditions and incorporated into other DM programs Cultural competency roadmap shared with communication writers within the company, along with Plain Language training Plans to develop additional culturally appropriate clinical quality outreach programs 2. Pilot identified need for member/patient education materials on effective patient-physician communication Custom course under development, to be launched in early 2011 DLP faculty provided feedback on the new patient communications training course. 13

14 8. Anchor new approaches: Applications of Indirect REL Data at WellPoint WellPoint s affiliated health plans now routinely use REL data and maps to: Identify hotspots of unscreened members Study provider access for minority members Identify individual minority members and aggregate regions for culturally/linguistically appropriate health screening reminders and health education materials Determine member threshold language needs to meet regulatory requirements Collaborate with network medical groups in quality improvement discussions Forge strategic alliances with industry stakeholders like the American Cancer Society and pharmaceutical firms to jointly work towards collaborative quality initiatives to reduce the gap in care Engage elected government officials to encourage open dialogues on the issue of health disparities We hope that sharing such transparency and engagement tools will improve the health of our communities and the quality of care overall 14

15 Moving the Mountain: A Chinese Parable If the industry continues to collaborate together, we can close the health disparities gap in the U.S.! 15

16 Questions? Contact: 16