Improving Health Care, Improving Lives: 2007 AHRQ Annual Conference Systems-Level Approaches to Reducing Racial, Ethnic and Income Disparities in Healthcare Quality Frederick P. Cerise, M.D., M.P.H Vice President Health Affairs and Medical Education Louisiana State University System September 28, 2007

Percent of Medicaid Eligibles and Louisiana Population, by Race Medicaid Eligibles Louisiana Population African- American African- American White Other SOURCE: DHH data as of 8/31/2007; LA population est

Two Approaches Systems-level intervention targeted to providers with lower performance on selected measures Establish expectations of all providers to be eligible to participate in Medicaid

Targeted Intervention 75 “bottom left” provider –Control: providers were mailed baseline indicator levels –Education only: providers were mailed baseline levels and nurse educators visited providers –Education + Reminder System: providers were mailed baseline levels, nurse educators visited providers, and providers had access to the reminder system All analyses are “intention to treat”

! Reminder

CONTROL over time, p = EDUCATION over time, p = EDUC+SYS over time, p = EDUC vs CONT, p = EDUC+SYS vs CONT, p = EDUC vs EDUC+SYS, p = These p-values are from tests comparing baseline to follow-up changes between pairs of groups These p-values are from tests comparing baseline to follow-up levels within each group

CONTROL over time, p = EDUCATION over time, p = EDUC+SYS over time, p = EDUC vs CONT, p = EDUC+SYS vs CONT, p = EDUC vs EDUC+SYS, p = 0.224

CONTROL over time, p = EDUCATION over time, p = EDUC+SYS over time, p = EDUC vs CONT, p = EDUC+SYS vs CONT, p = EDUC vs EDUC+SYS, p = 0.027

Conclusion African Americans and low income patients are disproportionately represented among Medicaid recipients. There is great variation in performance among practices caring for Medicaid recipients. Practices with more patients tend to have higher compliance with standards. Systems level interventions can improve outcomes for Whites and African Americans. Despite improvements, some disparities remain.

Provider Expectations Establish new expectations for Medicaid expansion Expectations track NCQA Physician Practice Connections

Medicaid Expansion Expectations for primary care providers –Access and communications –Patient tracking and registry –Care management –Patient self management support –Electronic prescribing –Test tracking –Referral tracking –Performance reporting and improvement –Interoperability

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