Tackling the Health Outcome Disparity Gap Together: A Primary Care Based Collaborative to Reduce Behavioral Health Outcome Disparities Associated with Race and Ethnicity Karen D. Lloyd, PhD, LP Art Wineman, MD Collaborative Family Healthcare Association 17 th Annual Conference October 15-17, 2015 Portland, Oregon U.S.A. Session # C4a in Period 4 October 17, 2015
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Tackling the Health Outcome Disparity Gap Together: A Primary Care Based Collaborative to Reduce Behavioral Health Outcome Disparities Associated with.
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Tackling the Health Outcome Disparity Gap Together:
A Primary Care Based Collaborative to Reduce Behavioral Health Outcome Disparities Associated with Race and Ethnicity
Karen D. Lloyd, PhD, LPArt Wineman, MD
Collaborative Family Healthcare Association 17th Annual ConferenceOctober 15-17, 2015 Portland, Oregon U.S.A.
Session # C4a in Period 4 October 17, 2015
Faculty Disclosure
The presenters of this session• have NOT had any relevant financial
relationships during the past 12 months.
Learning Objectives
At the conclusion of this session, the participant will be able to:
1. Identify 5 barriers to best health care provision and health outcomes in diverse populations.
2. Define 3 new ways to think about and analyze improvement opportunities to close health outcome disparities.
3. Describe how HealthPartners has and other organizations may work to obtain improved health outcomes with communities of color and immigrant communities.
Bibliography / Reference
1. The HHS Action Plan to Reduce Racial and Ethnic Health Disparities: A Nation Free of Disparities in Health and Healthcare, Department of Health and Human Services, USA, 2011.
2. Centers for Disease Control and Prevention, Health Disparities and Inequalities Report, United States, 2011. MMWR 2011; 60(Supplement): 1-114.
3. U.S. Department of Health and Human Services. National Center on Minority Health and Health Disparities. Social Determinants of Health Initiative.
4. Five-year impact of quality improvement for depression: results of a group-level randomized controlled trial. Wells K, Sherbourne C, Schoenbaum M, Ettner S, Duan N, Miranda J, Unützer J, Rubenstein L. Arch Gen Psychiatry. 2004 Apr;61(4):378-86
5. Interventions for enhancing medication adherence, Nieuwlaat R1, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, Agoritsas T, Mistry N, Iorio A, Jack S, Sivaramalingam B, Iserman E, Mustafa RA, Jedraszewski D, Cotoi C, Haynes RB, Cochrane Database Syst Rev. 2014 Nov 20;11:CD000011. doi: 10.1002/14651858.CD000011.pub4.
6. Institute of Medicine (IOM). In the Nation’s Compelling Interest: Ensuring Diversity in the Health Care Workforce. Washington, DC: The National Academies Press; 2004.
Learning Assessment
• A learning assessment is required for CE credit.
• A question and answer period will be conducted at the end of this presentation.
Agenda
3
1 Organizational Background
2 Diversity and barriers to health in diverse populations
Opportunities to reduce disparities in health outcomes
4 Specific examples and HealthPartners learnings
22,500employees
1,500,000members
1,000,000patients
Our Care Delivery System:
Hospitals HealthPartners Medical Group ClinicsPark Nicollet Health ServicesSpecialty Centers
Hospitals
Regions454-bed, level 1 trauma
Lakeview97-bed, acute care
Hudson25-bed, critical access
Westfields25-bed, critical access
Methodist426-bed, acute care
Amery25-bed, critical access
1,700physicians
55+specialties
50primary care locations
Our Ambulatory Practice
60+dentists
22locations
10
Our Ambulatory Practice
28Urgent Care locations
8Urgency Room level care
9Urgent Care + Retail Clinic level care
Mission
Vision
Values
To improve health and well-being in partnership with our members, patients and community
Health as it could be, affordability as it must be, through relationships built on trust
Excellence | Compassion | Partnership | Integrity
About HealthPartners
Diversity in Minnesota
Source: MNcompass
Patients We Serve
White
Black or A
frica
n-Americ
anAsia
n
Hispanic
or Latino
American-In
dian or Alaska
Native
Other0%
10%
20%
30%
40%
50%
60%
70%
80%
Active* HPMG Patients (2014) Twin Cities 7-county region (2014)
Seek First to Understand
• Barriers to health in diverse populations:– Cultural – Language– Financial – Transportation– Complexity of health care system
Approaches to Reduce Disparities
• Use plain language and “teach back”• Offer options• Convenience• Ensure follow-up care• Offer incentives• Make use of all opportunities• Community collaboration• Develop innovative engagement approaches
• $10 to $75 for completing a variety of health improving activities
• Personalized health activities with verification• Invite only those with opportunities
– Completing a CD face to face evaluation– Attending 3 psychiatry visits – Attending 3 primary care visits– Having 5 telephone dialogs with a BH care coordinator – Completing a 21 day chemical dependency program
Behavioral Health Incentives
2014 data:• Just over 100,000 Medicaid health plan
members • 5,013 were identified as at high risk for
psychiatric hospitalization • 2051 were engaged in Behavioral Health Case
Management (41%)• 97 members earned gift cards (5%)
Mental Health Stigma in Diverse Communities
• Stigma due to cultural or historical factors• Reducing / eliminating stigma though
community enlightenment and education• Collaborative planning• Partners:
– HealthPartners– NAMI MN (National Alliance on Mental Illness)– Twin Cities Public Television (TPT Channel 2)
• Close the gap opportunities• 2014 Antidepressant Continuation (6 months)
Commercial = 57.7%
Medicaid = 34.8%
White pts = 38.7%
Pts of color = 29.5%
Gap of 22.9 percentage points
Gap of 9.2 percentage points
Universal Care Delivery Process
• Same health processes for all patients but add extra attention to dissolve the unique barriers of diverse populations. – PHQ-9 for all– Added supports for people of color– In lieu of PHQ-9, Georgi Kroupin, PhD created a short
standardized questionnaire (Center for International Health)
– MN Dept Human Services: MH Screening for Immigrants
Universal Health Plan Process
• Same health processes for all members but add extra attention to dissolve the unique barriers of diverse populations. – First fill phone calls– Overdue refill phone calls– Incentive / gift card to defray expenses
Universal Enterprise Process
• Online interactive Beating the Blues– 5th grade reading level– Personalized invitation from primary care
physician, clinic based depression care manager, health plan
• Reducing MH stigma through Make It OK– Outreach through county public health
departments– Outreach to faith community
Quality Improvement Cycle
• It often takes 5 years to improve population health• It takes more effort if there is stigma or lack of cultural
understanding• New innovations must be developed, implemented and
evaluated • Our data from colorectal cancer screening suggests 5
years is a reasonable QI cycle• Our first year data on antidepressant focus resulted in
little movement
Lessons of Working Collaboratively to Reduce Health Outcome Disparities
• Thinking outside the box is one thing---putting it into action is quite another… – Fear of trying something new which alters your
typical work and typical roles– Fear of failing in public and being humiliated– Fear of disappointing others and losing credibility– Fear of the hard work it takes to create and
implement new protocols – Fear of getting guidance from & taking direction
from those you consider outside “My Team”
Collaboration Success Factors
– Triple Aim culture– Trust among leaders representing a variety
of areas and perspectives– Mutual encouragement to tackle the hard
problems– Creativity plus deep clinical expertise in
care and care support processes– Courage to move from the conceptual to
the practical--trying “what has never been”
Collaboration Success Factors
– Listening sincerely to input from the front line and patients and believing their input
– Finding champions among physician leaders to pilot, refine and prepare for spread
– Creating a dependably consistent process and maintaining accountability by calling out the score with meaningful metrics
– Momentum helps to overcome habitual ways of thinking and acting
Customize for Care that Meets Individual Needs
Equality Equity
Session Evaluation
Please complete and return theevaluation form to the classroom