Standing for Equity Eliminating Disparities and Promoting Wellness

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1 The 2014 Culturally Competent Healthcare Event DiversityInc October 22, 2014 Standing for Equity Eliminating Disparities and Promoting Wellness Winston Wong, MD Medical Director, Community Benefit Director, Disparities and Quality Initiative

2 Kaiser Permanente s History and Mission To provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. 2

3 Kaiser Permanente s Strategic Vision is..to be a Leader in Total Health by making lives better. We define Total Health as a state of complete physical, mental and social well-being for all people. We are committed to helping our members, our workforce, their families, and our communities achieve Total Health through the services we provide and by promoting clinical, educational, environmental, and social actions that improve the health of all people. 3

4 Drivers of Health Environmental and Social Factors 20% Personal Behaviors 40% Family History and Genetics 30% 10% Medical Care Source: Determinants of Health and Their Contribution to Premature Death, JAMA

5 Reflecting the Members and Communities We Serve 5

6 Black-White Standardized Mortality Ratios, all 6 Source: Health Affairs March 2005 vol. 24 no

7 Diversity & Inclusion Strategy CARE Provide best care and service for all populations to eliminate disparities and create equity in our communities WORKFORCE Optimize diversity at every level and create inclusive environments MARKETPLACE Provide the most compelling value for our diverse populations and communities SUPPLIER DIVERSITY & COMMUNITY PARTNERSHIP Build equity through businesses and jobs, and promote diverse and thriving communities Zero Disparities Zero Gaps in Representation Personalized Communications for All Billion Dollar Roundtable 7

8 KP Health Disparities Vision Kaiser Permanente (KP) will be a leader in eliminating disparities in health and health care. We will do this by providing equitable care to our members, targeting resources to areas of need in the communities we serve, and identifying and implementing strategies and policies that support equity in health nationwide, including universal health coverage. 8

9 Colorectal Cancer Screening, by Race/Ethnicity Kaiser Permanente Programwide 9 Source: Halvorson, G. Ending Racial, Ethnic and Cultural Disparities in American Health Care (2013)

10 Improving Colorectal Cancer Screening Among Hispanics Challenge Prevention Goal Leverage Points (potential indicators) Targets for Disparities Reduction Specific Disparities Reduction Strategies (examples) Improve Colorectal Cancer Screening among Hispanics¹ Screening Options for Average- Risk Adults* High-sensitivity guaiac fecal occult blood test (gfobt) every 1 2 years. Immunochemical fecal occult blood test (ifobt/fit) every 1 2 years. Flexible sigmoidoscopy at least every 10 years. Colonoscopy every 10 years. A combination of high-sensitivity gfobt every 1 2 years and flexible sigmoidoscopy every 10 years. A combination of ifobt/fit every 1 2 years and flexible sigmoidoscopy every 10 years. KP National Colorectal Cancer Screening Guideline: Link Colorectal Cancer Screening/Disparities Literature Lack of Patient Engagement (no visits, no internet use) Failure to Respond (contact, but no test on record Failure to Follow Up (positive test no record, no follow up Failure to Test (no test on record, late stage diagnosis) Access Barriers (location, schedule, transit, language, health literacy) Cultural and Linguistic Accessibility (knowledge of options, preferences for screening, perspectives) Real-Time Data for Clinical Staff (screening info available at time of any clinical encounter) Patient Knowledge/Beliefs/ Cultural Norms *Choice of test may be subject to regional and practice-level variation and may be related to patient screening rates. Assessment of Patient Barriers (solicit preferences/beliefs, customize screening options) Culturally & Linguistically Appropriate Outreach and Education (e-telenovelas, community based classes, one on one training through promatoras/ community health workers ) Clinical Staff Recommendation/ Re-enforcement (Health Connect prompts during check in for any visit) Partner with Community Providers and Organizations (barber shops, churches) 10

11 Colon Cancer Screening 11

12 Controlling High Blood Pressure, by Race/Ethnicity and Disparity between White and Black/African American Rates Kaiser Permanente Programwide 90% All Members Black or African American Asian or Pacific Islander Hispanic or Latino White HEDIS Natl 90th Pctile 11% 85% 80% 75% 70% 10% 9% 8% 7% 6% 5% 4% 3% 2% White Rate minus Black or African American Rate 65% 7.0% 4.5% 3.9% 4.1% 2010Q4 2011Q1 2011Q2 2011Q3 2011Q4 2012Q1 2012Q2 2012Q3 2012Q4 2013Q1 2013Q2 2013Q3 1% 0% 12 Source: Halvorson, G. Ending Racial, Ethnic and Cultural Disparities in American Health Care (2013)

13 Improving Hypertension Control Among African Americans Challenge Clinical Management Goals Leverage Points (potential indicators) Targets for Disparities Reduction Cultural Competency Proposed Disparities Reduction Strategies (examples) Clinic-Level Education/Feedback 13 Improve Hypertension Control among African Americans KP National Hypertension Guideline: Link Hypertension/ Disparities Literature Appropriate Medication/ Appropriate Dose (National HTN algorithm) Follow Up & Monitoring Medication Adherence Lifestyle Modification Failure to Intensify Therapy* Patient-Clinician Relationship (duration/ frequency of relationship, patient satisfaction)* Health Care Access (nonattendance at scheduled visits, non-adherence to medicines/ labs)* Patient Knowledge Patient Diet/ Exercise Patient Supports/ Resources *Available from existing KP data sources Decision Support Services Trust Building & Continuity of Care Accessibility of Information (language, literacy, context) Patient Cost Burden Ease of Access to Care Patient Education & Self-efficacy Patient Lifestyle Support (stress reduction) Community Education & Outreach Centralized Population Care Health Connect Reminders (consolidate Rx/ combo Rx/dose) Provider-Level Education/ Feedback New Patient Outreach Calls Culturally & Linguistically Appropriate Education & Case Management Barriers Assessment (motivational interviewing) Tech Based Self-Management Support (cell phones, internet) Referrals for Health System Specialty Services/Classes Family-Based Interventions (cooking classes, salt education) Partner with Community Providers and Organizations (barber shops, churches)

14 AIDET Building Trusting Relationships with African-American Members and Patients 14

15 Community to Clinic / Clinic to Community Innovation Project GOAL: 65% of participants will improve blood pressure control to 140/90 or better. 15

16 I have had high blood pressure since my forties. I used to stop at pharmacies and stick my arm in the machines, but I just don t see how they can be accurate. Having my pressure measured on a regular basis at Wally s keeps the information steady. And it has made me think more seriously about it. 16

17 The Journey We Are On Total Health Assessment Walking Promotion Health Education Community Benefit Healthy Eating Kaiser Foundation Health Plan, Inc. Workplace Safety