1. CHCS Center for Health Care Strategies, Inc. Reducing Racial and Ethnic Disparities in Managed Care Constance Martin Program Officer AcademyHealth Annual Research Conference June 25-28, 2006 Constance Martin Program Officer AcademyHealth Annual Research Conference June 25-28, 2006

2. Disparities Initiatives Medicaid Managed Care Disparities Collaborative –State Purchasing Institute –Health Plan QI Workgroup National Health Plan Collaborative Medicaid Managed Care Disparities Collaborative –State Purchasing Institute –Health Plan QI Workgroup National Health Plan Collaborative

3. Racial and Ethnic Disparities Reduction in Medicaid BCAP - Working with “early adopting” Medicaid MCOs and their state and provider partners to develop best practices in reducing racial and ethnic disparities. Purchasing Institute – Provide states with support in racial/ethnic data collection and using this information to target quality improvements. BCAP - Working with “early adopting” Medicaid MCOs and their state and provider partners to develop best practices in reducing racial and ethnic disparities. Purchasing Institute – Provide states with support in racial/ethnic data collection and using this information to target quality improvements.

4. Disparities Health Plan Workgroup Health Plans –Blue Cross of California –Healthfirst (NY) –Helix Family Choice (MD) –LA Care Health Plan (CA) –Medica of Minnesota –Molina Healthcare of Michigan –Monroe Plan for Medical Care (NY) –Neighborhood Health Plan of Rhode Island –Network Health (MA) –SoonerCare (OK) –UPMC Health Plan (PA) –Oregon Collaborative Health Plans –Blue Cross of California –Healthfirst (NY) –Helix Family Choice (MD) –LA Care Health Plan (CA) –Medica of Minnesota –Molina Healthcare of Michigan –Monroe Plan for Medical Care (NY) –Neighborhood Health Plan of Rhode Island –Network Health (MA) –SoonerCare (OK) –UPMC Health Plan (PA) –Oregon Collaborative Target Issues –Birth Outcomes –Adolescent and Child Immunizations –Asthma Care –Diabetes Care TOTAL MEDICAID/SCHIP ENROLLEES = 3,191,895

5. Stories to Share: Addressing Disparities in Asthma Care Blue Cross of California AIM: Increase the rate of asthma pharmacy consultations among eligible African-American members with asthma from 45 percent at baseline to within five percentage points of the rate for Caucasian, non-Latino members with asthma. ACTIVITIES: –Targeted 8 pharmacies for education and intervention. –Added second screen to identify reason for missed opportunity. –Established pharmacy report of asthma consults as percent of eligibles by pharmacy by ethnicity. Blue Cross of California AIM: Increase the rate of asthma pharmacy consultations among eligible African-American members with asthma from 45 percent at baseline to within five percentage points of the rate for Caucasian, non-Latino members with asthma. ACTIVITIES: –Targeted 8 pharmacies for education and intervention. –Added second screen to identify reason for missed opportunity. –Established pharmacy report of asthma consults as percent of eligibles by pharmacy by ethnicity.

6. Stories to Share: Addressing Disparities in Asthma Care Blue Cross of California RESULTS –The rate of asthma consultations for AA members increased from 44% to 51%. –The disparity decreased from 8% at baseline to 6% at last measurement. Blue Cross of California RESULTS –The rate of asthma consultations for AA members increased from 44% to 51%. –The disparity decreased from 8% at baseline to 6% at last measurement.

7. Stories to Share: Addressing Disparities in Birth Outcomes Monroe Plan for Medical Care AIM: Reduce the Difference in NICU Admission Rates between African-American Teens and White Teens by 50% ACTIVITIES: –Expansion of Healthy Beginnings Program with Focus on African-American Teens with Social Outreach (BabyLove). –Outreach Worker Readily Relating to Target Population: Ethnicity, Experience, Her Own Success. Monroe Plan for Medical Care AIM: Reduce the Difference in NICU Admission Rates between African-American Teens and White Teens by 50% ACTIVITIES: –Expansion of Healthy Beginnings Program with Focus on African-American Teens with Social Outreach (BabyLove). –Outreach Worker Readily Relating to Target Population: Ethnicity, Experience, Her Own Success.

8. Stories to Share: Addressing Disparities in Birth Outcomes Monroe Plan for Medical Care Demonstrated Decrease in NICU Admission Rate for All African American Teens from 18.1% to 13.5% Monroe Plan for Medical Care Demonstrated Decrease in NICU Admission Rate for All African American Teens from 18.1% to 13.5%

9. National Health Plan Collaborative Health Plans AETNA CIGNA Harvard Pilgrim Health Care HealthPartners Highmark Inc. Kaiser Permanente Molina Healthcare UnitedHealth Group WellPoint, Inc. Health Plans AETNA CIGNA Harvard Pilgrim Health Care HealthPartners Highmark Inc. Kaiser Permanente Molina Healthcare UnitedHealth Group WellPoint, Inc. Target Issue: –Diabetes Care TOTAL ENROLLEES = 76,748,227

10. Stories to Share: Addressing Disparities in Diabetes Care Kaiser Permanente Aim: Within selected Hispanic and African American populations, increase performance on the following outcome measures by 10%: 1) Proportion with good HgA1c control and 2) Proportion adhering to A.L.L. regimen. Activities: –Partner with Kaiser Latino Center of Excellence in Colorado which has bilingual and bicultural staff and providers –Coordination and ownership of the activity across multiple intra-organizational stakeholders Results –Pending Kaiser Permanente Aim: Within selected Hispanic and African American populations, increase performance on the following outcome measures by 10%: 1) Proportion with good HgA1c control and 2) Proportion adhering to A.L.L. regimen. Activities: –Partner with Kaiser Latino Center of Excellence in Colorado which has bilingual and bicultural staff and providers –Coordination and ownership of the activity across multiple intra-organizational stakeholders Results –Pending

11. Stories to Share: Addressing Disparities in Diabetes Care United Healthcare Aim: To improve diabetes care for Hispanic and African American members in targeted regions as measured by HbA1c, lipid control, BP control, eye exam, and foot exam rates. Activities: –DocSite, web based patient registry at targeted physician offices. –Enrollment into appropriate disease management programs. –Implement community wide initiatives in target regions (FL, OH, KY, KS). Results: –Pending United Healthcare Aim: To improve diabetes care for Hispanic and African American members in targeted regions as measured by HbA1c, lipid control, BP control, eye exam, and foot exam rates. Activities: –DocSite, web based patient registry at targeted physician offices. –Enrollment into appropriate disease management programs. –Implement community wide initiatives in target regions (FL, OH, KY, KS). Results: –Pending