Health equity

Graphic of the week

Dashboard_DisparitiesGraphic_StandAlone

 

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.


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.”


Graphic of the week

MaternalMorbidity_Fig3_Standalone
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.


Walmart expands doula services for employees to address racial disparities in birth outcomes

Walmart is expanding health care coverage for employees who want to enlist the services of a doula, a person trained to assist women during pregnancies, to address racial inequities in maternal care (Source: “Walmart expands health services to address racial inequality,” Associated Press, June 22).

After first offering doulas to employees in Georgia last year, the nation’s largest retailer said Wednesday that it will expand the same benefit to its employees in Louisiana, Indiana and Illinois.

Black women are three times more likely to die from a pregnancy-related cause than white women, largely due to differences in the quality of health care, underlying chronic conditions and structural racism, according to the Centers for Disease Control and Prevention. Employing a doula as a part of a birthing team decreases C-sections by 50%, shortens the time of labor by 25% and decreases the need for other medical interventions by more than 50%, according to the National Black Doulas Association.

Earlier this month, the Ohio House passed a bill that would provide Medicaid coverage for licensed doula services. (Source: “Doula services could soon be covered by Medicaid after racial equity bill passes Ohio House,” Ohio Capital Journal, June 9).


Ohio House approves Medicaid coverage of doulas in attempt to address racial disparities

A bill that is aiming to combat racial disparities in infant and maternal mortality rates passed the Ohio House during a session Wednesday (Source: “Doula services could soon be covered by Medicaid after racial equity bill passes Ohio House,” Ohio Capital Journal, June 9).

House Bill 142 would provide Medicaid coverage for licensed doula services.

Between 2008 and 2017, Black women died during birth about two and a half times more than white women, according to the Ohio Department of Health. Black women also have twice the amount of birth complications, which ODH data show cannot be attributed to factors such as the pregnant person’s income, education, marital status, tobacco/ alcohol use and insurance coverage.

Doulas “can save lives,” said Dorian Wingard, partner and COO of Restoring Our Own Through Transformation (ROOTT), an organization dedicated to addressing the needs of women of color. “They can prevent the death of mothers, they can prevent the death of children.”

Doula services can also result in lower rates of preterm births, as well as help save money for families, according to Wingard.

Republican state Rep. Tom Brinkman, one of the bill’s sponsors, said he convinced his fellow Republicans to vote for the bill by explaining that it could allow Ohio to save money, since doula services lead to fewer preterm births, which are expensive for the state.

“The hardest thing was to talk to my colleagues and say, ‘look, we are going to expand Medicaid, which we don’t necessarily want to do because we’re trying to restrain costs, but what it’s going to do is result in overall savings because we won’t be paying for [as many complications],” Brinkman said.


HHS launches office of environmental justice to address health inequities

The Department of Health and Human Services (HHS) has announced it is establishing an Office of Environmental Justice (OEJ), bringing awareness to the impact of environmental health inequities (Source: “HHS Launches Office of Environmental Justice, Tackles Health Inequity,” Patient Engagement HIT, June 3).
 
“The blunt truth is that many communities across our nation – particularly low-income communities and communities of color – continue to bear the brunt of pollution from industrial development, poor land-use decisions, transportation, and trade corridors,” HHS Secretary Xavier Becerra said in the press release. “Meeting the needs of these communities requires our focused attention. That’s why HHS is establishing the Office of Environmental Justice.”
 
Until June 18, 2022, the OEJ will be seeking public comment to identify the best strategies for addressing environmental injustices and health inequities for disadvantaged communities.


Study: Communities of color have much higher air pollution rates

A block-by-block analysis of air quality in the San Francisco Bay area found that communities of color are exposed to 55% more of a chemical that contributes to smog than mostly White communities (Source: “Block-by-block data shows pollution’s stark toll on people of color,” Washington Post, May 25).

The data released Tuesday by Aclima, a California-based tech company that measured the region’s air quality block-by-block for the first time. While the Environmental Protection Agency gauges an area’s air quality with fixed monitors, the new survey unearthed more granular data by sending low-emission vehicles equipped with sophisticated technology to traverse neighborhoods at least 20 times each.

These forays revealed that poor people of all ethnicities experience a 30% higher exposure to nitrogen dioxide compared to wealthier residents, and concentrations can vary up to 800% from one end of a block to the next.


Policy experts call for better Medicaid data collection to address health inequity

A team of healthcare policy experts is calling for an overhaul of the ways in which Medicaid data is collected and analyzed to address health equity issues (Source: “Health Policy Experts: Medicaid Data Processes Must Be Improved to Achieve Equity,” Heathcare Innovation, May 25).

Writing in Health Affairs, the researchers say that “the COVID-19 pandemic has highlighted and exacerbated health care inequities in the United States. Calls to address health care disparities have intensified, and the Biden Administration has made equity a central component of its policy agenda. The confluence of these social and political forces has reinvigorated discussion about how to address health care inequities in public insurance programs, and refocused attention on Medicaid — which now covers more than 86 million Americans — as a lever for advancing health equity.”

The authors point to the 2021 decision by the Center for Medicare and Medicaid Innovation (CMMI) to explicitly add health care equity as one of its five core objectives. CMMI also specifically prioritized initiatives to improve care and outcomes for vulnerable and underserved populations in Medicaid.

“These efforts depend, however, on the ability to measure disparities in access to care, quality of care, and health outcomes by race and ethnicity,” the authors wrote. “Due to lack of high-quality data, it remains impossible to fully evaluate the state of health equity in the Medicaid program.”