National health care reform package promises to reduce number of uninsured Americans

MN Community Measurement data helping medical groups address disparities by focusing quality improvement efforts specifically on insured, but underserved, populations

The national health care reform package signed by President Obama recently promises to significantly reduce the number of uninsured Americans. According to the Congressional Budget Office, 31 million Americans who are currently uninsured will gain health care coverage under the federal legislation. While health insurance coverage is a key factor in ensuring that consumers get the health care services they need, it may not be enough. As found in a recent study by MN Community Measurement, even when patients have health insurance, if they are of lower socioeconomic status or are persons of color, there is a persistent gap between their health status and the health status of other patients.

For the past three years, MN Community Measurement, a nonprofit organization with a mission to measure and publicly report health care quality information, has assessed the gap between the rate at which physicians achieve health care "best practices" for their patients enrolled in state-funded health insurance programs such as Medical Assistance or MinnesotaCare (called Minnesota Health Care Programs patients in the report), and the rate at which they achieve those "best practices" for their patients who have insurance through an employer or through Medicare managed care. Compared with the overall population in Minnesota, patients who are enrolled in the state-funded Minnesota Health Care Programs are more likely to have a lower socioeconomic status and to be persons of color, American Indians, persons with disabilities and elders. MN Community Measurement conducts this work under a contract with the Department of Human Services. The third annual report issued this week indicates that, although there has been a reduction of that gap on nine of ten measures over the last three years, the gap persists. The report is available on the organization's website at www.mncm.org.

"We are making progress," said Jim Chase, president of MN Community Measurement, "but it is slow because there is no easy fix. Our conclusion is we need to do more than just treat everyone the same and hope they benefit from the improvements in care. To really get at the gaps, we need also to target interventions specifically at those patients who have socioeconomic, racial or cultural factors in play that are affecting their health status." Some groups, including HealthEast, achieved higher than average rates in applying best practices to their patients enrolled in state-funded health care plans on some measures, such as optimal diabetes care, controlling blood pressure, and treatment of colds and sore throats without unnecessary prescription antibiotics. On some of those measures, such as optimal diabetes care, medical groups such as HealthEast not only had a higher than average rate in achieving best practices, but also had a smaller than average gap between their patients who are enrolled in state-funded health plans and their patients who have insurance coverage through an employer or Medicare managed care.

To help health care providers target their interventions, for the first time, MN Community Measurement has also taken a closer look at the gap by comparing the care provided to patients of different racial groups. A statewide look at differences between racial groups reveals, for example, that American Indians are the least likely to achieve health care best practices in four of the ten measures: optimal diabetes care, controlling high blood pressure, receiving appropriate screening for cervical cancer and receiving appropriate childhood immunizations. Patients of Asian descent are the least likely to receive appropriate colorectal cancer screenings.

HealthPartners is among the medical groups most often achieving not only a high rate of achieving best practices for patients enrolled in state-funded health plans but also reducing the gap between this population and their commercially insured patients. They identify as one key element of their success the fact that they have been using their electronic health record system to record patients' race and language preference. They use that information to make sure they have an interpreter available to participate in an upcoming appointment or to plan for health education in the patient's preferred language. HealthPartners Clinics also have instituted a system that generates automatic reminders for patients to come in for preventive screenings, such as a colonoscopy, mammogram or PAP test. "We have made reducing health disparities a top priority," said Dr. Beth Averbeck, Associate Medical Director of HealthPartners, "and have customized our care plans to address the unique health care needs of specific patient groups. For example, we recently launched an initiative aimed at saving lives by providing colorectal cancer screening at an earlier age for African American patients. Organizations such as the American College of Gastroenterology and the Institute for Clinical Systems Improvement recommend that regular colorectal cancer screening for African Americans should begin at age 45, compared to age 50 for other races."