Graphic of the week

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HPIO’s 2021 Health Value Dashboard concluded that one reason Ohio ranks poorly (47th out of the 50 states and D.C.) is that many Ohioans experience poorer outcomes and live shorter lives because of policies, systems and beliefs that discriminate against and unfairly limit access to resources. According to the Dashboard, racism and other forms of discrimination drive troubling differences in outcomes across Ohio. This includes racist and discriminatory beliefs and interactions among Ohioans and structural racism and discrimination embedded within systems and across sectors, rooted in ageism, ableism, xenophobia, homophobia and other “isms” or “phobias.”  As the graphic above shows, Ohioans experiencing the worst health outcomes are also more likely to be exposed to risk factors for poor health. These include trauma and adversity, toxic stress, violence and stigma, and inequitable access to resources.

Earlier this week, HPIO hosted the first meeting of its Health Value Dashboard Advisory Group as it begins planning for the 2023 Dashboard. The new edition is expected to be released in March or April 2023.


In rural areas, COVID hits Black, Hispanic communities hardest, although gap appears to be narrowing

At the peak of the Omicron wave, Covid killed Black Americans in rural areas at a rate roughly 34% higher than it did white people, new research has found, although the gap appears to be narrowing in recent months (Source: “In Rural America, Covid Hits Black and Hispanic People Hardest,” New York Times, July 28).

Across the small towns and farmlands, new research has found, Covid killed Black and Hispanic people at considerably higher rates than it did their white neighbors. Even at the end of the pandemic’s second year, in February 2022, overstretched health systems, poverty, chronic illnesses and lower vaccination rates were forcing nonwhite people to bear the burden of the virus.

In towns and cities of every size, racial gaps in Covid deaths have narrowed. That has been especially true recently, when major gains in populationwide immunity have tempered the kind of pressure on health systems that appears to hurt nonwhite Americans the most.


Insurer reduces healthcare disparities after tying executive bonuses to the issue

A California-based Medicare Advantage plan is touting its success at improving health disparities by tying its executives’ bonuses to the issue (Source: “How one insurer tied executive performance bonus to reducing healthcare disparities,” MedCity News, July 25).

One aspect SCAN Health Plan looked at was medication adherence among its members, numbering  270,000 across Arizona, California and Nevada. While medication adherence exceeded 80% for all of SCAN’s members, there was still a difference between races. About 86% of the company’s White members took cholesterol medications as prescribed, compared to 83% of Black members and 81% of Hispanic members, according to an essay from the company published in Harvard Business Review.

A year after launching the initiative, SCAN Health brought cholesterol medication adherence up to 87.4% for Black members, 86.6% for Hispanic members and 89.6% for White members. Similar improvements were seen in diabetes medication adherence.

SCAN officials say the company achieved the improvement in disparities by tying about 10% of its senior managers’ bonuses to their success in achieving this disparity reduction.

The company chose this course of action “to make it real,” SCAN CEO Sachin Jain said. “It’s not real until you make it real for people. Otherwise, it’s kind of like ‘Oh, yeah, it’d be great if we did this.’ And we wanted to send a strong signal to our organization that this was not something that was nice to have. This is a must do.”


Health systems leaders from across U.S. detail health equity initiatives

As the COVID-19 pandemic exacerbated existing health equities, health systems nationwide have implemented a series of initiatives to reduce disparities (Source: “13 leaders on health equity initiatives launched in the last year,” Becker Hospital Review). 

Leaders from 13 health systems from across the country answered a series of questions on their health equity initiatives and shared lessons learned so far with editors of Becker Hospital Review.


Graphic of the week

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Click to enlarge

Recent analysis by HPIO has found that stark differences in maternal health outcomes signal that not everyone has what they need to live a healthy life before, during and after pregnancy.

The graphic above, from the HPIO fact sheet “Racial and Geographic Disparities in Maternal Morbidity and Mortality,” shows urban and Appalachian counties have the highest rates of maternal morbidity in Ohio. Additionally, across both urban and Appalachian counties, Black mothers have the highest rates of maternal morbidity

According the fact sheet, “High maternal morbidity and mortality rates are preventable. State and local policymakers have many options to address racism and discrimination, inequitable community conditions, toxic stress and poor prenatal care access.”


Kasich: Health insurers can drive health equity efforts

Speaking at an insurance industry conference last week, former Ohio Gov. John Kasich said health insurers are well-positioned to drive improvement on health inequities and disparities (Source: “AHIP 2022: How payers could lead the charge in addressing health equity,” Fierce Healthcare, June 22).

Kasich said during a keynote presentation at AHIP's 2022 conference that the payer industry's muscle gives it the ability to bring stakeholders together to drive critical collaboration on health equity. That includes providers, policymakers, physicians and community leaders, he said.

"You ought to be the leader in that you have the data," Kasich said. "This would be such a great thing for people in our country who have been excluded from the power they ought to have."


Report finds flawed Medicare data inhibits analysis of health disparities

Inaccuracies in Medicare's race and ethnicity data have hurt the program’s ability to assess health disparities, a new federal report found (Source: “Flawed Medicare data hampering analysis of health disparities, inspector general says,” Becker’s Payer Issues, June 15).

According to a report from the HHS Office of the Inspector General, Medicare's enrollment data is inconsistent with federal data collection standards, and the inconsistencies "inhibit the work of identifying and improving health disparities within the Medicare population,"

By comparing Medicare data to other federal sources, the report found that Medicare's race and ethnicity data is less accurate for certain groups, particularly for beneficiaries who identified as American Indian/Alaska Native, Asian/Pacific Islander or Hispanic. 

The report includes recommendations that CMS develop its own source of race and ethnicity data, use self-reported race and ethnicity information to improve data for current beneficiaries, develop a process to ensure that the data is as standardized as possible and educate beneficiaries about CMS efforts to improve the race and ethnicity information.


Study finds race, ethnicity are seldom mentioned in pediatric clinical guidelines

Race and ethnicity were unexplored in most American pediatric clinical practice guidelines published in the last 5 years, according to the results of a systematic review (Source: “Race unexplored in most pediatric clinical care guidelines, review finds,” Helio, June 13).

According to the study, which was published in JAMA Pediatrics, 70% of the guidelines did not mention race or ethnicity at all. The researchers also found that when race or ethnicity was mentioned, 57% of the time it was used in a way that could exacerbate or have a negative impact on inequities and only 15.1% of clinical practice guidelines include language specifically intended to reduce disparities in medicine.

“I think that shows a missed opportunity for us as medical organizations to be proactive in talking about health care inequities and systemic racism in our field,” said Courtney A. Gilliam, MD, a member of the division of hospital medicine in the department of pediatrics at Seattle Children’s Hospital and a co-author of the review. “We have a long way to go in interrogating clinical practice guidelines.”


Faulty oxygen readings added to COVID-19 disparities, study finds

Covid-19 care, including distribution of lifesaving therapies, was significantly delayed for Black and Hispanic patients due to inaccurate oxygen readings from devices that can work poorly in darker-skinned individuals, according to a new study (Source: “Faulty oxygen readings delayed Covid treatments for darker-skinned patients, study finds,” Stat News, May 31).

Widely used pulse oximeters, which measure oxygen levels by assessing the color of the blood, have been under increasing scrutiny for racial bias because they can overestimate blood oxygen levels in darker-skinned individuals and make them appear healthier than they actually are. A 2020 study comparing oxygen levels measured by the devices with readings taken from “gold standard” arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients. Two months after that report, the Food and Drug Administration issued a safety communication alerting patients and clinicians that the devices could be erroneous in those with dark skin.

The new study, published in May in JAMA Internal Medicine, found that  the inaccuracies in oxygen measurement occurred at higher rates not only in Black patients, but also in Hispanic and Asian patients, compared to white patients. Those inaccuracies had real-world consequences. The study provided evidence that undetected low oxygen levels led to delays in Black, Hispanic and Asian patients receiving potentially lifesaving therapies such as the drugs remdesivir and dexamethasone, and in many cases, led to patients not receiving treatment at all.


Graphic of the week

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Analysis from HPIO late last year found that the most notable change in tobacco use in recent years has been the shift away from combustible cigarettes and toward e-cigarettes among teens and young adults (see graphic above). By 2019, only 4.9% of Ohio high school students reported that they had smoked a cigarette in the past 30 days, while e-cigarettes surpassed alcohol and became the most commonly used drug among teens. Similarly, the percent of 18-24-year-olds reporting e-cigarette use jumped 77% from 2016 to 2020, making this the group of adults with the highest rate of e-cigarette use in 2020 (19%).

Learn more in HPIO’s fact sheet, Tobacco, Alcohol and Health Series: Health Impacts of Excessive Alcohol Use in Ohio.