Informing Public Policy to Address Health Care Disparities Boisey Barnes, MD, F.A.C.C. Founding Member and Trustee Association of Black Cardiologists

Health care disparities – inequalities in care directly associated with: Health care disparities – inequalities in care directly associated with: Race/ethnicity Race/ethnicity Age Age Gender Gender Health status Health status Low Income level Low Income level Place of residence (inner city, rural) Place of residence (inner city, rural) Functional status Functional status Ability to communicate Ability to communicate

Disparities are present in: Disparities are present in: Burden of illness Burden of illness Access Access Use Use Quality of care Quality of care Outcomes Outcomes

According to the AHRQ According to the AHRQ (Minority Health: Recent Findings AHRQ Pub. No. 09-P002, July 2009) Significant challenges remain in accessing care for cardiovascular disease Significant challenges remain in accessing care for cardiovascular disease Treatment and outcomes are poor for heart disease, congestive heart failure and heart attack Treatment and outcomes are poor for heart disease, congestive heart failure and heart attack Blacks and Hispanics are much less likely to receive invasive cardiovascular services such as cardiac catheterization, bypass surgery or angioplasty Blacks and Hispanics are much less likely to receive invasive cardiovascular services such as cardiac catheterization, bypass surgery or angioplasty Black and Hispanic patients stay in the hospital longer and have higher total charges as compared to Whites Black and Hispanic patients stay in the hospital longer and have higher total charges as compared to Whites Blacks are more likely to die following cardiovascular procedures than Hispanic or White patients Blacks are more likely to die following cardiovascular procedures than Hispanic or White patients

Important Elements - Informing Public Policy Important Elements - Informing Public Policy Investment in preventive care Investment in preventive care Focus on health care workforce Focus on health care workforce Support for research investments Support for research investments

Investment in Preventive Care Investment in Preventive Care Waiver of copays for preventive services Waiver of copays for preventive services Creation of Community Preventive Services Grants (½ of funds to be used for services to reduce health care disparities) - very important for heart failure and hypertension clinics Creation of Community Preventive Services Grants (½ of funds to be used for services to reduce health care disparities) - very important for heart failure and hypertension clinics Must increase public awareness of available benefits through community outreach Must increase public awareness of available benefits through community outreach

Focus on Workforce Focus on Workforce Critical shortages in primary and cardiovascular care Critical shortages in primary and cardiovascular care Estimated shortage of 16,000 general clinical cardiologists in 2025 Estimated shortage of 16,000 general clinical cardiologists in 2025 Blacks, Hispanics and Native Americans comprise only 6 percent of practicing physicians and 3 percent of cardiologists Blacks, Hispanics and Native Americans comprise only 6 percent of practicing physicians and 3 percent of cardiologists Investment needed in workforce and cultural competence Investment needed in workforce and cultural competence

Support for Research Investment Support for Research Investment NIH funding NIH funding AHRQ funding AHRQ funding CDC funding CDC funding Patient Centered Outcomes Research Institute (PCORI) and comparative effectiveness research - evaluates clinical effectiveness, outcomes and risks/benefits of two or more medical treatments to address a specific medical condition in representative patient populations Patient Centered Outcomes Research Institute (PCORI) and comparative effectiveness research - evaluates clinical effectiveness, outcomes and risks/benefits of two or more medical treatments to address a specific medical condition in representative patient populations Must ensure PCORI directs adequate resources to disparities research Must ensure PCORI directs adequate resources to disparities research