Health Disparities Elena Rios, MD, MSPH President & CEO National Hispanic Medical Association QualityNet Conference | Baltimore, MD December 13 – 15, 2011 Follow us on Tweet with our conference hashtag: #QualityNet11

2 Demographic Trends

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Reprinted from US Census Bureau. Hispanics in the United States. Available at: Accessed November 10, Demographic Trends

Key Trends Minorities face disparities in risk factors and chronic disease rates in America –By 2042, over half of Americans will be minority populations –Latinos – immigrants, mixed families with strong cultural values -will be 1 out of 4 Americans –Minority communities – poor, air pollution, toxic homes, food deserts, stress Our nation is undergoing a major transformation : –Cultural Competence & language requirements in hospitals/clinics and for future providers in medical education and public health –Health care reform expands health care coverage to Hispanics and African Americans and increases the need for education and outreach efforts –Quality and value payments for care that is patient centered in medical homes –Disparities in obesity, CVD, chronic diseases for minority populations remain high –New demand for community-based health prevention and research National Hispanic Medical Association and its Foundation seek to cultivate public and private partnerships to make a positive impact promoting prevention awareness & good will in new and growing Latino communities and markets around the nation

6 HHS 2011 Disparities Plan Assess the impact of policies, programs, resources Data and use of data –New : race, ethnicity, language, disability status –Target high disparities areas/resources –Dual eligibles, obesity, oral care, CVD, readmissions –CPBR and Dissemination and adoption Quality measures and incentives –Value based reimbursement –Patient centered care, need new measures Workforce and leadership for future –CLAS Standards, diversity

7 OMH National Partnership for Action Recommendations Awareness –Regional Councils, Communications, Partnerships Leadership –Minority representation needed to change health delivery Health Outcomes of Minority Populations Culturally and Linguistically Appropriate Services Standards adoption –Increase health workforce diversity and training Data and Evaluation –CBPR

ACA, Disparities & Access Increased insured patients outreach & demand for all services with critical shortages of safety-net providers, need for increased nursing Health Insurance Exchanges – consumer grants to develop outreach with community health workers that is culturally and linguistically appropriate –Information & Websites –Standards for benefits – presented in a culturally and linguistically appropriate manner, health literacy

ACA, Disparities & Quality National Strategy for Quality Improvement in Health Care –Priorities that have the greatest potential for improving health outcomes, efficiency, and patient-centeredness of health care, for all, including vulnerable populations –Quality measures – Medicare/Medicaid hospitals, physicians experience, quality, use of info for pts and caregivers Equity of health services/disparities across health disparity populations Patient-centered

ACA, Disparities & Quality HHS lead - strategic plans, incentives w/public and private payers, mandates racial/ethnicity and language data Office of Minority Health at OS, CDC, FDA, HRSA, CMS, SAMHSA; Institute for Minority Health and Health Disparities at NIH Key National Indicator System (and Independent Institute like the National Academy of Sciences) –Pt outcomes and functional status, H-IT, pt safety, effectiveness, pt centeredness, appropriateness, efficiency, equity of services and health disparities, patient satisfaction

ACA, Disparities & Quality Reimbursement – including activities to prevent hospital readmissions – comprehensive discharge program with pt centered education and counseling Best clinical practices that improve pt safety and reduce medical errors through evidence based medicine and Health Information Technology H-IT : EMR and PMR to include health disparities information from provider/patient/community assessments – for example, language needs

ACA, Disparities & Quality Center for Medicare/Medicaid Innovation –Pt centered medical home models –Community health teams, small practice med homes – chronic care, self management –Home health chronic care services –Best practices –Healthcare innovation zones –Programs that address health care disparities and show impact

ACA, Disparities & Prevention National Prevention, Health Promotion and Public Health Council (Fed agencies under HHS) –Provide coordination and leadership at the Federal level with respect to prevention, health promotion, public health system and integrative health care in the US Develop a National Prevention and Health Promotion Strategy – health disparities priority Prevention and Health Promotion Investment Fund ($10B) Community Transformation Plan –to promote healthy living and reduce disparities (including social determinants) –Schools, restaurants, worksites –Community Prevention

ACA, Disparities & Workforce National Health Care Workforce Commission – HHS, DEd, DOL –Integrated health workforce training, capacity of prim care –Medicare/Medicaid GME –Nursing, oral, mental, allied, and public health workforce, diversity –Geographic distribution of providers vs need –Increased focus on primary care providers HHS Workforce to Reduce Disparities: –Diversity to increase URM minority health professionals –Cultural Competence Training for all providers

ACA, Disparities & Research Patient Centered Outcomes Research –Comparative Clinical Effectiveness Research Importance of dissemination of research and adoption by providers Community involvement in research Impact assessments on health disparities needed

Cultural Competence Training is Key to Decreasing Health Disparities Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. (Adapted from Cross, 1989). Unequal Treatment Report (2001, IOM) showed the existence of bias among physicians and called for cultural competency training, language services Should be an Essential Benefit for minority patients

17 Culture and Health Care Significant implications for cost, quality of care and most importantly, health outcomes:  variations in patient recognition of symptoms;  thresholds for seeking care;  the ability to communicate symptoms to a provider who understands their meaning;  the ability to understand the prescribed management strategy;  expectations of care (including preferences for or against diagnostic and therapeutic procedures); and  adherence to preventive measures and medications

18 CLAS Standards – 2001 The collective set of culturally and linguistically appropriate services (CLAS) mandates, guidelines, and recommendations issued by the United States Department of Health and Human Services Office of Minority Health intended to inform, guide, and facilitate required and recommended practices related to culturally and linguistically appropriate health services (National Standards for Culturally and Linguistically Appropriate Services in Health Care Final Report, OMH, 2001).

Cultural Competence Standards Federal Law – Title VI Medical Education – AAMC, LCME, ACGME Joint Commission NCQA NQF standards Licensing – required in CA, NJ Language Services in Medicaid – in 13 states

Cultural Competence and Quality There is excellent evidence that tracking/reminder systems can improve quality of care, and fair evidence that multifaceted interventions, provider education interventions, and interventions that bypass the physician to offer screening services to racial/ethnic minority patients can improve quality of care. There is, however, excellent evidence for improvement in provider knowledge, good evidence for improvement in provider attitudes and skills, and good evidence for improvement in patient satisfaction. (AHRQ, Strategies for Improving Minority Healthcare Quality (Publication No. 04-E008-01, 2004)

NHMA & NHHF– Who are We? Established in 1994 in DC, NHMA is a non-profit 501c6 association representing 45,000 Hispanic physicians in the U.S. Mission: to empower Hispanic physicians to improve the health of Hispanic populations with Hispanic medical societies, residents, students and public and private partners Established in 2002, NHMA’s foundation, National Hispanic Health Foundation, a 501c3 aimed at research & education activities – at NY Academy of Medicine & affiliated with NYU Wagner Graduate School of Public Service

NHMA Board of Directors Kathy Flores, MD, Chairwoman, Director, UCSFresno Latino Research Center Ciro Sumaya, MD, MPHTM, Past Chairman, founding Dean, Texas A&M Rural public Health School Louis Aguilar, MD, Treasurer, Tucson, AZ Sam Arce, MD, ViceChair, NYC Onelia Lage, MD, Secretary, Professor, Pediatrics, U of Miami Elena Rios, MD, President/CEO Washington, DC Carol Brosgart, MD, San Francisco, CA Emilio Carrillo, MD, MPH, Professor, Cornell Weill School of Medicine Jorge Girotti, PhD, Assoc. Dean, U of Illinois, Chicago Medical School Paloma Hernandez, MPA, CEO, Urban Health Inc. Leonora Lopez, MD, Chairwoman, Council of Medical Societies, Alb, NM Jorge Puente, MD, Regional President of Asia, Pfizer Joan Reede, MD, MPH, Associate Dean, Harvard School of Medicine Jaime Rivera, MD, Consultant, DE Richard Zapanta, MD, Monterey Park, CA Vanessa Salcedo, MD, Chairwoman, Council of Residents Ray Morales, Coordinator, Latino Medical Students Association

NHHF Board of Directors Mark Diaz, MD Chairman, Principal, Alivio Medical Group, Sacramento, CA Conchita Paz, MD Secretary -Treasurer, Principal, Family Care Associates, Las Cruces, NM Elena Rios, MD, MSPH President, NHHF, NY Jo Ivey Boufford, MD President, New York Academy of Medicine Dolores Leon, MD A Woman’s Place, Sacramento, CA Gary Pelletier Director, Pfizer Helpful Answers Miguel Sanchez, MD Professor, Dermatology NYU School of Medicine Yasmine Winkler United Healthcare, Chicago

National Hispanic Medical Association – what do we do? Serve as a resource for White House, Congress, and Federal agencies on health policies and programs Support Hispanic physician leadership at national and state level Provide partnership opportunities for advancement of Hispanic health

NHMA Network 2011 Hispanic State and Regional Medical Societies National Hispanic Health Professional Leadership Network –National Association of Hispanic Nurses –Hispanic Dental Association –Latino Caucus of APHA –Latino Forum of Health Executives –Assoc of Hispanic Health Execs of NY –Regional Mental Health Associations Latino Medical Student Association

26 Contact Information Elena Rios, MD, MSPH NHMA Annual Conference: April 26-29, 2012 Washington, DC – “Innovations that Improve the Health of Hispanics, Families and Communities”