1. Report Card Working Group of the MA-HDC 06.22.09 1 The Massachusetts Report Card Measuring Our Progress Toward the Elimination of Racial, Ethnic, and Linguistic Disparities in Health Health Disparities Council Meeting June 22, 2009

2. Report Card Working Group of the MA-HDC 06.22.09 2 Massachusetts Report Card Working Group (Participating Members)  Mary Crotty, MNA  Sherry Dong, Tufts  Joe-Ann Fergus, MNA  Pam Jones, BPHC  Georgia Simpson May, DPH  Joel Weissman, EHS (advisor)

3. Report Card Working Group of the MA-HDC 06.22.09 3 Today’s Agenda  Report Card Working Group Update  The MA Report Card Purpose Our Framework Key Concepts Report Card Structure  Indicators Exercise  Next Steps

4. Report Card Working Group of the MA-HDC 06.22.09 4 Report Card Working Group Update  Working group meetings were held on June 2, and June 16 Process reviewed and goals set for moving forward The next meeting is Scheduled for July 22  Report Card Group members also met with staff from the AGs office on June 11 (Maura Healey and Lois Johnson) The goal of this meeting was to explore the concept of how or if existing policies and laws may contribute to or help to alleviate disparities.  Per the suggestion of Rep. Rushing at the last council meeting, the report card group emailed out a request for input to the council members.  The report card group is seeking input from council members regarding the model and content of the report card.

5. MA Report Card: Purpose  Identify priority health, social, and policy indicators for Massachusetts.  Create a systematic approach to tracking our progress, over time, in reducing racial, ethnic, and linguistic disparities.  Provide the residents of the Commonwealth with useable information on the health and wellness of Massachusetts. Report Card Working Group of the MA-HDC 06.22.09 5

6. 6 MA Framework for Addressing Health Disparities Societal/Policy Factors Access to Health Care Personal Health Behaviors Extent and Quality of Health Care and Outcomes Individual Factors Community Factors Institutional Transformation Version 3+: 6/18/09

7. Report Card Working Group of the MA-HDC 06.22.09 7 Key Concepts for Developing a MA Report Card I.Racial, Ethnic & Linguistic Health Disparities II.Not a Static Document Periodic Updates Parking Lot III.Report Card Structure Health and Social Statistics vs. Social Policy Formatting IV.Selection Criteria for Indicators

8. Report Card Working Group of the MA-HDC 06.22.09 8

9. 9 Key Concept III: Report Card Structure Health Status Indicator Morbidity (prevalence/incidence of illness) Mortality (death rate) Contributory Factors Associated with the Indicator 1.Health Care Utilization  Access and quality 2.Social Determinants  Basic needs, social well-being, community attributes (including environmental) 3.Personal Practices/Individual Factors

10. Report Card Structure, cont. 4.Social Policy Levers Civil Rights (“obvious” discrimination) Other policies, laws, etc that appear to be race neutral but may affect the health of racial-ethnic minorities disproportionately  Zoning / restrictive ordinances  Mortgage and foreclosure policies and practices  Medicaid rates resulting in poor access/low quality  Workplace health and inspections, e.g., nail salons, auto body shops, taxi drivers Report Card Working Group of the MA-HDC 06.22.09 10

11. Report Card Working Group of the MA-HDC 06.22.09 11 KIS MIV Keep It Simple, Make It Visual

12. Report Card Working Group of the MA-HDC 06.22.09 12 King County, WA

13. Report Card Working Group of the MA-HDC 06.22.09 13 King County, WA

14. Report Card Working Group of the MA-HDC 06.22.09 14 Formatting Considerations  Content  Length  Resources Stop for Discussion

15. Report Card Working Group of the MA-HDC 06.22.09 15 Source: MDPH, Bureau of Health Information, Statistics, Research and Evaluation, Health Survey Program Example: Age-Adjusted Asthma ED Visits and Hospitalizations by Race/Ethnicity 2003-2005

16. Report Card Working Group of the MA-HDC 06.22.09 16 What do we want to know? What can we measure? Can we intervene and where? Are there policy implications? _______________________________________ % who need inhalers who do not have them % living in substandard housing % living in areas with poor air quality Educational level Household income The rate of asthma ED visits and hospitalization may be a proxy for other health care access issues timely access to ambulatory services Use the Example to Build Our Report Card

17. Report Card Working Group of the MA-HDC 06.22.09 17 Example, cont. Asthma Related ED Visits by R/E (MA: 1,038/100,000) Contributory Factors Associated with the Indicator 1.Health Care Utilization a.______ 2.Social Determinants a.______ 3.Personal Practices/Individual Factors 4.Social Policy Levers a.Medicaid Reimbursement b.Environmental Hazards Black: 2,276/100,000 Hispanic: 2,080/100,000 Asian: 227/100,000 White: 841/100,000

18. Report Card Working Group of the MA-HDC 06.22.09 18 Indicators What do we want to know?  Selection Criteria  What’s been identified  What needs to be included  Prioritize

19. Report Card Working Group of the MA-HDC 06.22.09 19 Key Concept IV: Indicator Selection Criteria  Availability of Data (Measures and Statistics)  Known Instances of Disparities  Size of Disparities  Amenable to intervention an indicator we can influence an area we can adjust to impact the indicator can identify an area(s) in the system to apply an intervention(s) that will change the indicator  Presence of Policies which would impact disparity (Social Policies)

20. Report Card Working Group of the MA-HDC 06.22.09 20 Our Indicators Review “Proposed Indicators and Ranking” Document  What we have  What else do we want to know Stop for Discussion

21. Report Card Working Group of the MA-HDC 06.22.09 21 Let’s Prioritize  Write In Missing Indicators  Ranking of Indicators On a Scale of 1 (Low) to 5 (High)

22. Report Card Working Group of the MA-HDC 06.22.09 22 MA Report Card, Next Steps  Compile  Format  Present a Mock-up of a MA Report Card

23. Report Card Working Group of the MA-HDC 06.22.09 23 Thank You!