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Workshop E-2: Reducing chronic disease disparities in primary care: targeting health centers and managed care organizationsThe Health Disparities Collaboratives: Chronic Care Management Programs that Improve Health Outcomes, Reduce Costs, and Improve DisparitiesSince 1999, over 500 health centers nationwide are currently participating in a national initiative aimed at improving health outcomes for chronic conditions among the medically vulnerable, particularly minorities. Overseen by the federal Bureau of Primary Health Care, these Collaboratives employ the chronic care model to strengthen the process of care through use of extensive patient registries to identify targeted patients. The Collaboratives improve clinicians’ ability to monitor the health of individual patients and guarantee continuity of care. Also key to the design of the Collaboratives is the improvement of clinicians' skills and educating patients on self-management of their conditions. Participating health centers have seen dramatic improvement in health outcomes while reducing costs of care for diabetes, hypertension, asthma, cancer, depression, and HIV/AIDS. Health centers have also been successful in "spreading" this process of care towards the delivery of other health services, including preventive services. Speakers for the session will include Lisa Cox, NACHC, who will provide background on health centers and the Health Disparities Collaboratives, and how the Collaboratives have been successful in improving health and reducing disparities while reducing costs; and Nancy Stern, CEO, Eastern Shore Rural Health System, who will discuss how the success of her health center’s participation in the Collaborative process, as well as the importance of the outreach model with the Collaboratives. She will also talk about how they established local and state level relationships spread this process of care to throughout the communities they serve. Lisa Cox is the Assistant Director, Public Health Policy with the National Association of Community Health Centers. Lisa handles issues regarding the Section 330 Health Centers program authorization, the National Health Service Corps, and other Public Health Service Act programs. Before coming to NACHC, Ms. Cox was Senior Legislative Representative for AIDS Action, and Program and Policy Director at the National Women’s Health Network. In addition to her work in the non-profit sector, Ms. Cox spent three years on Capitol Hill, working first as a staff assistant to U.S. Senator Tom Harkin (D-IA) and as a legislative assistant to former U. S. Representative Alan Wheat (D-MO). Lisa received her B.A. in Political Science and American Studies from the University of Iowa in 1991. Nancy J. Stern, Chief Executive Officer of Eastern Shore Rural Health System, Inc., is a graduate of the West Chester State College in West Chester, Pa. with a BS Degree in Education. Her masters work and certification are in Health Education. She holds a certificate in Health Care Management from Old Dominion University, Norfolk, Va. Ms. Stern completed the MATCH Program, a NACHC sponsored training for CEOs in 1999. She has been contributing author to several Health Education guidebooks for community health education programs. Ms. Stern has been employed with Eastern Shore Rural Health a total of 18 years. Her background in education brought her into her first position as a Health Educator and throughout her years of training and experience in leadership roles she has served ESRHS as Director of Health Education, Director of Human Resources and Chief Operation Officer. She became CEO in 2000. Moving from the Philadelphia area 24 years ago, Ms. Stern and her husband, Jim, reside in Belle Haven, Va. and have three children.
Improving Health Care Quality for Diverse Populations in Managed CareDisparities in health associated with race, ethnicity and income have been widely recognized for some time. But, it took several recent reports culminating with the Institute of Medicine’s Unequal Treatment (2002), to focus attention on the reality that health care delivery itself is an important component of these disparities. The National Healthcare Disparities Report and the National Healthcare Quality Report recently issued by AHRQ found clinical performance was worse for racial and ethnic minority groups in countless areas of health care. To date, there have been few efforts to develop mechanisms for addressing the issue. In many ways managed care provides a unique leverage point for improving health care quality for racially and ethnically diverse populations. Managed care organizations can encourage consistency across provider groups and promote best practices through appropriate incentives. Through case management and member education programs, health plans can offer targeted services to members most in need. Further, Medicaid, by virtue of the eligibility determination process in many states, has ready access to data on the race and ethnicity of its enrollees. Small demonstration projects already have begun with HRSA funding wherein state Medicaid agencies are partnering with MCOs to match data on race with quality indicators (e.g., HEDIS) to identify and address areas of disparity in health care utilization and outcomes. 1 In this workshop, the Center for Health Care Strategies (CHCS) will describe the goals and anticipated outcomes of the two demonstrate projects underway lead by managed care organizations and involving state, provider, and consumer support. With funding from The Robert Wood Johnson Foundation and The Commonwealth Fund, CHCS is exploring data mining techniques and developing innovative clinical and administrative strategies applicable in particular to Medicaid/SCHIP, but also with potential relevance to Medicare and employer-based coverage programs. Twelve managed care entitles partnering with state, provider, and other stakeholders have been selected through a competitive application process to develop best practices in identifying, stratifying and intervening with racial and ethnic minorities. The project also will provide states with support in racial/ethnic data collection and using this information to target quality improvement efforts. Also, CHCS is serving as the learning organization for the Agency for Health Research and Quality (AHRQ) and The Robert Wood Johnson Foundation’s (RWJF) sponsored National Health Plan Collaborative to Reduce Health Disparities. Beginning in September 2004 CHCS and IHI will facilitate a 24-month BCAP with 10 national health plans serving Medicare, Commercial, and Medicaid populations to improve health care for racially and ethnically diverse populations with diabetes Since its inception, the CHCS has been advancing the way in which health plans approach quality improvement. More than 120 health plans, PCCM programs, and External Quality Review Organizations – representing 13.5 million Medicaid beneficiaries - have engaged in quality improvement initiative lead by the center. The session facilitators will guide participants through the learning framework for each initiative and discuss its potential for achieving improvements in health care quality for racially and ethnically diverse populations. At the conclusion of this workshop, participants will be able to appreciate, understand, potentially apply a collaborative quality improvement approach to improving clinical care for racially and ethnically diverse members, and develop a strategic plan for building organizational and stakeholder support of quality improvement initiatives in this area. Participants will learn the session with the knowledge of strategies being implemented and tested in the field to reduce disparities in health. Deborah Bradley Kilstein, MBA, JD is the Director of Program Management at CHCS. She brings more than 25 years experience in state publicly financed health care, having served in various leadership positions at the New Jersey Department of Human Services. Most recently, Ms. Kilstein served as Chief of Staff, in which she managed the provision of social services for more than one million New Jersey residents; Deputy Commissioner, in which she was responsible for the management of the Division of Medical Assistance and Health Services (Medicaid and New Jersey Family Care); Acting Director of the Division of Medical Assistance and Health Services; and Director of the Office or Policy and Planning. Ms. Kilstein earned a JD from the Rutgers University School of Law - Camden, an MBA, with a concentration in management, from Temple University, and a bachelor’s degree in nursing from Trenton State College. Constance Martin, MHA is a Program Officer for the Medicaid Managed Care Program at the Center for Health Care Strategies, Inc. (CHCS). In this role, she works primarily with the Best Clinical and Administrative Practices (BCAP) program, funded by the Robert Wood Johnson Foundation to improve care provided by health plans serving Medicaid and SCHIP populations. Prior to CHCS, she was a Medicaid Health Systems Analyst with the Bureau of Managed Health Care (BMHC) in Ohio. At BMHC, Ms. Martin worked on projects related to quality of services delivered from health plans involved in the Medicaid managed care program. Ms. Martin completed an administrative residency at Children’s National Medical Center in Washington D.C., where she developed and implemented a human resource policy in accordance with JCAHO standards. Ms. Martin also completed an internship in the Quality Operations and Improvement department at The Ohio State University Medical Center. She has a Bachelor of Arts in Anthropology from Case Western Reserve University and a Master’s Degree in Health Administration from The Ohio State University.
1 Nerenz D., Bonham V., Green-Weir R., Joseph C., Gunter M. “Eliminating Racial/Ethnic Disparities in Health Care: Can Health Plans Generate Reports?” Health Affairs. May/June 2002: 21(3). 259-263. |
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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: |
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