Esther S. Han, MPH Senior Health Care Analyst, Research July 15, 2009 Innovative Practices in Multicultural Health Care: Health Plan Initiatives

© 2008 National Committee for Quality Assurance Session Agenda Introductions An Overview of NCQA’s Efforts to Narrow Disparities in Care NCQA’s Recognizing Innovation in Multicultural Health Care Award Program Keystone Mercy Health Plan Virginia Premier Health Plan Q&A

© 2008 National Committee for Quality Assurance NCQA: A Brief Introduction Private, independent non-profit health care quality oversight organization founded in 1990 Mission: To improve the quality of health care Committed to measurement, transparency and accountability Unites diverse groups around common goal: improving health care quality

© 2008 National Committee for Quality Assurance Achieving the Mission 70% of all insured Americans are in NCQA-Accredited plans –109 million people including 92% of people in HMOs Over 90% of managed care organizations report HEDIS ® quality data Over 14,000 physicians have earned NCQA Recognition; our RPs form the basis of quality improvement programs nationwide 38 states and the federal government rely on NCQA Accreditation and HEDIS Blend of standards and performance measures unique to achieving success in NCQA programs HEDIS ® is a registered trademark of NCQA.

© 2008 National Committee for Quality Assurance NCQA Efforts in Cultural Competence/Disparities NCQA has focused on racial/ethnic disparities since 2003 Our efforts include the following: – Innovation in Multicultural Health Care Awards program – Multicultural Health Care: A Quality Improvement Guide – Technical Assistance Project for practices services minority populations – Developing standards for culturally and linguistically appropriate services

© 2008 National Committee for Quality Assurance Multicultural Health Care: A Quality Improvement Guide

© 2008 National Committee for Quality Assurance Supporting Small Practices: Lessons for Health Reform Lack of resources, business management skills Lower patient adherence to treatment plans Language and communication barriers Lack of sophistication with technology Inability to track and manage patient needs and outcomes Staff turnover

© 2008 National Committee for Quality Assurance New Standards to Address Areas for Organizations to Improve Care Race/ethnicity and language data –Data elements, methodology, storage and protection –Reporting and use of data to improve quality and enhance culturally appropriate care Language Services –Provision, monitoring, and evaluation of services Network and Workforce Diversity –Improve ability to serve culturally and linguistically diverse members Accountability and Quality Improvement –Program structure and systems to address CLAS and reduce disparities –Using data to assess disparities and language services and designing interventions to reduce disparities and improve CLAS

© 2008 National Committee for Quality Assurance Innovation in Multicultural Health Care NCQA’s Awards Program Ample documentation of disparities, language and cultural needs Evidence base for improving disparities/addressing cultural competence is limited –Generic and targeted quality improvement activities reduce disparities –Language services: increase overall quality; improve patient understanding, medication use, and safety; reduce unnecessary ER utilization –Cultural competency training improves physician self-rated knowledge What works best? What are Health Plans doing to reduce disparities and address CLAS?

© 2008 National Committee for Quality Assurance Innovation in Multicultural Health Care Awards for Health Plans Objectives – Identify and recognize innovative practices in health plans – Provide transferable models for adoption and dissemination – Add to the evidence base about effective methods for addressing CLAS/disparities Funded by The California Endowment

© 2008 National Committee for Quality Assurance Awards Evaluation Criteria Strong program design, evidence-based intervention Innovative/creative Impact on services & outcomes Sustainable Transferable Organizational integration & leadership

© 2008 National Committee for Quality Assurance Characteristics of Award Winning Initiatives Product Line Commercial Medicaid Medicare RegionNational Midwest Northeast South West Multiple Regions Target Population Doctors Patients Community FocusHealth Care Disparity Language Cultural Competence

© 2008 National Committee for Quality Assurance Health Plan Award Winners Aetna Blue Cross of California State Sponsored Business Chinese Community Health Plan Highmark, Inc. CareFirst BlueCross BlueShield, Maryland CIGNAKeystone Mercy Health Plan Chinese Community Health Plan Excellus Health PlanMolina Healthcare of MI Health Net of California Harvard Pilgrim Health Care UnitedHealthcare Latino Health Solutions HealthPartnersHealth Alliance PlanUnitedHealthcare Kaiser Permanente Virginia Premier Health Plan, Inc. Keystone Mercy Health Plan, PA UnitedHealthcareWellpoint, Inc. L.A. Care Health PlanUPMC For You Molina Healthcare of MI

© 2008 National Committee for Quality Assurance FOR MORE INFORMATION: NCQA’s Innovative Practices Report details award-winning initiatives Information from 2006, 2007 & 2008 winners

© 2008 National Committee for Quality Assurance For More Information: Esther S. Han Senior Health Care Analyst, Research