Value-based care brings new urgency to the effort to end disparities in healthcare access and outcomes for minorities.
How do you make sure hospitals deliver high-quality care? Fine them if they deliver bad care. Just look at the effort to reduce readmissions. Medicare’s penalty program seems to be motivating hospitals in ways regulations, reports, and lawsuits can’t.
Now, the pay-for-value era promises to put some power behind the effort to end disparities in healthcare access and outcomes. Research shows that minorities are more likely to experience the kind of bad outcomes that result in penalties from Medicare. For example, non-white patients are more likely to experience avoidable hospitalizations and suffer from medical errors, says Joseph Betancourt, MD, director of the Disparities Solutions Center at Massachusetts General Hospital in Boston.
Thus it makes sense for hospitals looking to thrive in the new world of healthcare delivery to identify and address disparities as part of the effort to improve quality.
“There is a clear understanding that the new pressure points sit squarely around the intersection of quality and vulnerable populations,” Betancourt says. “Going forward, our ability to succeed will be predicated on how we care for those who are most vulnerable.”
Betancourt says the Institute of Medicine’s 2001 study, “Crossing the Quality Chasm,” gave an initial push to address health disparities. The landmark study said equitable care “does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.”
Still, the effort has been slow to spread nationally, he says. The Centers for Disease Control and Prevention looked at data from 2001 to 2009 and concluded: “Some improvements in overall rates and even reductions in some health disparities are noted; however, many gaps persist.”
The coming changes in the healthcare payment system may be the key to closing those gaps.
“This push toward value makes it critical for us to meet the needs of all the populations who we care for, not just a select few,” Betancourt says. “We know that disparities exist—lower quality, high costs, greater variation. That’s the epitome of low value.”
One problem in dealing with inequities has been a lack of data necessary to target needs and evaluate programs, he says. Betancourt’s group designed a database they call a “diversity dashboard” to track the race, ethnicity, and language of each patient admitted to the hospital. The 2014 findings were just released—the seventh year of reporting.
After reviews of data on compliance with guidelines for heart attack, heart failure, pneumonia, and surgery, the dashboard shows no instances last year where non-white patient received less care than white patients. At the same time, it identified equity issues the hospital needed to address, including prostate cancer screening services for Hispanic men and well-baby visits for infants less than 15 months of age in non-English speaking families.
The report also offers a sort of demographic picture of which groups use which services. More African-American and Hispanic patients are seen in the emergency department than in inpatient services. Pediatrics, obstetrics/gynecology, and burns are among the top inpatient services for all minority groups. White patients were more likely to use urology, orthopedics, and neurosurgery.
Betancourt’s group offers training to hospital executives. One of them is Juana S. Slade, the diversity officer for AnMed Health, which operates a 630-bed hospital in Anderson, SC. Slade spoke in a webcast earlier this month as part of the run-up to a national equity roadmap meeting scheduled for July.
AnMed set up its own dashboard to identify and address underserved and costly patients, she says. One problem that turned up: high 30-day readmissions rates for African-American heart attack patients.
Slade says the data allowed AnMed clinicians to see that those patients shared some underlying conditions and zip codes. So they set up an alert in the emergency department for patients with that profile. Each patient was assigned a case manager, who worked on finding out why patients with the suspect profile were being readmitted.
Getting the staff to buy in and do more was a challenge, Slade said.
“How do you add one more project, one more thing to do—literally—to peoples’ lists?” she says. “How do we move something like disparities to a priority status when the organization already agrees on the relevance?”
She started at the place patients enter the system. Most of the needed data is collected at patient registration, so Slade and her team work closely with intake staff on mechanics of collecting information. They needed to learn how to have a “safe candid, ongoing conversation” with patients and families about why they are asking questions about race and language, she says.
All hospital employees, including administrators, need to take steps to be to address disparities, says John Whittemore, who speaks for the National Forum for Latino Healthcare Executives. Hospitals with diverse leadership are better prepared to serve diverse communities, he says.
Professional groups, including those representing LGBT and Asian executives, are working with students to introduce them to careers in healthcare management. But they need role models, Whittemore says. “They don’t have a ton of people at the top they can look at and say, ‘Hey, he looks like me, or she is like me.’ “
Convened by the American Hospital Association, the upcoming roadmap meeting will offer an opportunity for groups focused on minority health and healthcare leadership to get together for the first time, Whittemore says.
With payment increasingly linked to outcomes, that linkage now has a new urgency.
“There was an acknowledgment that equity is a key part of quality,” Betancourt says. “In our world, that’s not enough. There has to be financial skin in the game.”
Source: http://www.healthleadersmedia.com/