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| Workshop C-8: Improving quality of care for Medicare beneficiaries: interventions to improve care for underserved communitiesCenters for Medicare & Medicaid Services Racial and Ethnic Disparities EffortsThe presenters will provide a brief overview of the Centers for Medicare & Medicaid Services initiative to reduce disparities for Medicare beneficiaries who are members of populations that are underserved by the health care system. The populations that are the focus of the CMS initiative are African American, American Indian/Alaska Native, Asian/Pacific Islander, and Hispanic. Underserved rural populations are also included. Medicare provides the means for many members of minority groups to access medical services. However, racial and ethnic minorities are less likely than their white peers to have Medicare reimbursement for services. The cause of disparities in health indicators are varied and complex and underserved populations are at risk for many adverse health outcomes and their health indicators remain behind those of the general population. The challenge of coming from behind requires a major commitment to identify and to address the causes underlying higher levels of disease and that are common to and different from group to group. The Centers for Medicare & Medicaid Services and the Medicare Quality Improvement Organizations (QIOs) have responded to the challenge with interventions to improve quality of care to reduce health disparities. The variations in disparities across populations and social and cultural differences present unique challenges in developing and implementing interventions that are culturally appropriate for each population. CMS contracts with Quality Improvement Organizations to develop and implement interventions to improve the quality of care for underserved populations in each state and territory. Ms. Harley is the Co-Government Task Leader for the Centers for Medicare & Medicaid Services Underserved and Rural Beneficiary Reduce Disparities Project with Quality Improvement Organizations. This Project focus on reducing health disparities for underserved populations and on increasing access to care. Ms. Harley has served as the Coordinator of the Centers for Medicare & Medicare Services National Influenza and Pneumococcal Campaign, Team Leader for the CMS/CDC Standing Orders Project, Lead for the Good Neighbor Flu Project, and Co-Lead for the Horizons Pilot Project with Historically Black Colleges and Universities to improve the quality of health care for African American communities. Ms. Harley works in the Quality Improvement Group of the Office of Clinical Standards and Quality. She has experience in the areas of federal contracting, quality improvement programs, rural health care, and health promotion and disease prevention.
Mr. Preston is the Co-Government Task Leader of the Centers for Medicare & Medicaid Services Underserved and Rural Beneficiary Reduce Disparities Project with Quality Improvement Organizations. Mr. Preston is a Clinical Epidemiologist in the Seattle Regional Office of CMS, where he also performs duties as a Scientific Officer to several Quality Improvement Organizations. Mr. Preston is a representative for other task areas in which QIOs work, including development of the Low Volume/Rural Hospital task and Hospital Payment Monitoring Program. Mr. Preston has experience in pharmaceutical and health services research. Mr. Preston holds a doctorate in Gerontology from the University of California, San Francisco, and a Master of Public Health from the University of Washington in Health Services Research and Epidemiology.
Culturally Appropriate Strategies Implemented by Quality Improvement OrganizationsUnder the direction of the Centers for Medicare and Medicaid Services (CMS), the Quality Improvement Organizations (QIO) consist of a national network of fifty-three QIOs responsible for each U.S. state, territory, and the District of Columbia. QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations. The program also safeguards the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services. CMS designed the Health Care Quality Improvement Program (HCQIP) to improve health outcomes of all Medicare beneficiaries regardless of personal characteristics (e.g., socio-economic status, health status, ethnic group), physical location (urban or rural), or setting (e.g., physicians' offices, M+COs, hospitals, nursing homes). Over the last few years, QIOs have been charged with helping to reduce healthcare disparities among underserved Medicare beneficiaries in their state. They were directed to specifically demonstrate an understanding of the underserved population and expertise in defining the cause of the disparity. At the end of the project, QIOs had accomplished much more than a simple understanding of the population. They developed intervention tools that addressed the cultural beliefs and practices of the beneficiaries. They demonstrated a measurable improvement in clinical process of care measures, and in many cases, reduced the disparity. Project leaders agree that it was worth the time and effort spent learning about the cultural issues of these populations. They also assert that because of the culturally appropriate tools that were developed and administered, they received a positive response from the community that serves these populations. Susan Brittman currently serves as the Special Studies Program Manger of the Center for Healthcare Quality. She is responsible for leading the national effort to identify effective ways of classifying underserved populations, defining population targets for intervention implementation, and collecting and disseminating successful interventions to the Quality Improvement Organizations in every state. Previously, she served as the analytic lead for the statewide effort to reduce the disparity in the mammography rate for low-income, minority women in Tennessee. In this role, Ms. Brittman lead the effort in developing tools to assist the provider community in implementing effective systems changes.
Cultural Competency: You Don’t Know What You Don’t Know Bio Sketch Initiative The project’s design is two pronged: 1) increasing the health literacy levels of Medicare beneficiaries and 2) increasing cultural competency and health literacy awareness of health care providers. The work includes collaboration with various health care, community and faith based organizations throughout our target areas. Successes
Challenges Lessons learned
Mary “Toni” Flowers RN, BA, Director of Health Disparities
& Cultural Competency
Keys to MAAM Success: Mature African Americans for Mammography CoalitionThe intervention to improve the rate of screening for breast cancer in an African American community will be presented. Getting to know the community was an important aspect of this intervention. Listening to the women in the community and getting to know their needs and wants and then planning together an intervention to increase screening mammograms was important in the successful achievement of the project objective. Building a trusting relationship was necessary for this to happen. The Quality Improvement Organization staff got to know the women of the community by talking with them one-on-one and getting to know the key members. Interventionists, especially those of a different cultural background, as was the case in this initiative, must get to know the culture of the population and embrace it not try to change it.
The presenters will discuss the development of the MAMM coalition and the work done to encourage African American women to get regular screening mammograms. The success of our approach was due to the development a sense of ownership in the intervention by the members of the community coalition involved in the intervention. The goal was to begin the development of a self-sustaining organization that would continue the health promotion project. It was important that coalition members share the work load and develop a sense of responsibility for getting their friends and other community members to have mammograms. The intervention reduced the disparity in the rate of mammography between the African American women and the Caucasian women in the intervention counties. Important lessons learned were to keep the goals and task of the project simple and emphasize the importance to African American women of having a regular breast cancer screening. Saying ‘Thank you.” was another important lesson learned. Saying “thank you” is an underrated award in acknowledging a job well done and in highlighting community and individual accomplishments and is an effective motivator. Romie Lutz is the Health Educator for Quality Insights of Delaware (QID), the Medicare Quality Improvement organization for Delaware. As health educator, Ms. Lutz is responsible for educating Medicare beneficiaries about Medicare rights, the importance of using Medicare preventive services, and the role of being a good Medicare consumer. In addition, Ms. Lutz supports and assists with many HCQIP outpatient projects of QID and the nursing home quality initiative. Prior to joining Quality Insights, Ms. Lutz spent 7 years working at Delaware Health and Social Services (DHHS). At DHSS Ms. Lutz served as Health Educator for the Division of Services for Aging and Adults with Physical Disabilities. Thereafter, she worked for the Division of Public Health as the Director of the Screening For Life Program; the State’s Breast and Cervical Cancer Early Detection Program. Ms. Lutz has a Bachelor’s of Science degree in Public Health/Health Promotion from West Chester University.
Ms. Savini, in her role a Director of Communications, has worked with all of the HCQIP programs at Quality Insights of Delaware. She worked as member of the team of the 6th Scope of Work breast cancer and African American project, MAAM - Mature African Americans for Mammography Coalition. Prior to her appointment at Quality Insight, Ms. Savini worked in public relations for 15 years and was responsible for public relations for several community-based social service agencies.
Taking a Multi-Pronged Approach to Address Mammography Screening Disparities in an Underserved Medicare PopulationBreast cancer is the second most common cancer among women. Yearly mammograms are still the best method available for diagnosing breast cancer at a stage when it can be most effectively treated. Medicare recommends, as well as covers, an annual screening mammography for all women age 50 and over who have Medicare coverage. However, despite this coverage, mammography screening rates for the Medicare population have been relatively stagnant, with only about 60 percent of Medicare eligible women receiving this important preventive health benefit. Delmarva Foundation, the Quality Improvement Organization (QIO) for the District of Columbia (DC) and Maryland conducted a study of women with Medicare between the ages of 50 and 67 and found wide disparities in mammography screening rates among low-income and minority populations. In the District of Columbia, the overall screening rate was 53 percent, however the screening rate for the African American women in DC was 51 percent compared to 61 percent for Caucasian women. In some parts of the city, the rates were below 50 percent. Delmarva found similar findings in Maryland, with Baltimore City and parts of Prince Georges County having the lowest rates. Delmarva has engaged several strategies to boost screening rates targeting the following audiences:
Ms. Richmond will share the tools and techniques that Delmarva is using to reach these various audiences. Delmarva is still in the process of measuring the success of these various strategies, but has already learned some important lessons. Lessons learned will be shared during the conference. Deneen Richmond is the Executive Director for Delmarva Foundation, District of Columbia. In addition to managing the five healthcare quality focused contracts in the District of Columbia, Ms. Richmond works corporate wide to create and implement programs to help health care providers improve quality of care. Delmarva holds the Quality Improvement Organization (QIO) contract with the Centers for Medicare & Medicaid Services (CMS) to promote medically necessary high-quality health care for Medicare beneficiaries in the District of Columbia and Maryland. Delmarva also has a contract with the District of Columbia Medicaid Administration to provide quality oversight for Medicaid managed care plans, and perform quality and utilization reviews for acute, specialty and long-term care facilities. Prior to joining Delmarva, Ms. Richmond was at the National Committee for Quality Assurance (NCQA) for more than 7 years. Most recently, she served as the Assistant Vice President for Policy. In this role, she was responsible for directing and overseeing all aspects of Accreditation and HEDIS performance measurement policy. While at NCQA, Ms. Richmond also worked in the Measures Development, HEDIS Policy, and State and Federal Projects departments. Prior to coming to NCQA, Ms. Richmond was the Director of Clinical Quality Improvement at Baltimore Medical System, Inc., a large community health center network in Baltimore, Maryland. She has also worked with the George Washington University Medical Center in a variety of roles. Ms. Richmond has over sixteen years of experience in the health care industry. She has a clinical background in nursing and a Master’s degree in Health Administration from the George Washington University.
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| Fourth
National Conference is presented by State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations |
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
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Diversity Rx is sponsored by: |
 The National Conference of State Legislatures |
 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
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