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On The Road To Eliminating Health Disparities

CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association.® Registered trademark of the Blue Cross and Blue Shield Association. ® ’ Registered trademark of CareFirst of Maryland, Inc.

Community Health Partnership Washington, D.C

May 20, 2008

Malcolm Joseph, III, MD, MPH

Medical Director

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About CareFirst

Location of Region(s)Maryland, District of

Columbia, Northern Virginia, and Delaware

Products offeredPoint of Service plans (POS); Preferred Provider Organizations (PPO); Managed Care Organization (HMO)Consumer Directed Health Plans

Membership3.3 Million members

Market Share39% in service area

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Mission Statement

To provide health benefits of value to customers across the region comprised of Maryland, Delaware and the National Capital area. To fulfill this mission, CareFirst commits:

• To offer a broad array of quality, innovative insurance plans and administrative services that are affordable and accessible to our customers

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Mission Statement

• To fairly address the needs of customers in each of the jurisdictions in which we operate.

• To conduct business responsibly as a non-profit health services plan, to ensure the Plan’s long-term financial viability and growth.

• To support public and private efforts to meet needs of persons lacking health insurance.

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Mission Statement

• To collaborate with the community to advance health care effectiveness and quality

• To foster health systems integration and health care cost containment to benefit the people in areas we serve

• To promote respect, fairness and opportunity for our associates

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Increasing Diversity

Minority Population and other language spoken is 38%

% Speaking Another Lanuguage at HomeLess than 10%Between 10% and 20%Between 20% and 30%Between 30% and 40%Greater than 40%

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The IOM Report• The IOM report1 called “Unequal

Treatment: Confronting Racial and Ethnic disparities in Healthcare”, found and documented extensively that racial and ethnic disparities exist regardless of socioeconomic factors such as health insurance coverage and income.

• Other reports: National Healthcare Disparities Report2 provided data for measuring the effectiveness of national initiatives to reduce disparities.

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IOM Recommendations

• CareFirst has adapted the IOM recommendation to “promote the consistency and equity of care through the use of evidence-based guidelines”.

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Quality Care• The IOM Report defines quality care for the

21st Century.

• CareFirst acceptance of IOM’s definition of quality care requires that care be safe, timely, effective, efficient, equitable and patient-centered.

• These parameters of quality care are particularly applicable to minority populations who have poorer quality of health and worst outcomes

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Quality & Safety

Effects of poor quality care• 44,000-98,000 deaths/year from medical errors -

more than breast cancer, AIDS, or motor vehicle accidents (IOM, To Err Is Human, 1999)

• Only 55% of patients receive recommended care (McGlynn, New England Journal of Medicine, 2003)

• Poor quality costs $17-$29B/year

Effects of poor quality care• 44,000-98,000 deaths/year from medical errors -

more than breast cancer, AIDS, or motor vehicle accidents (IOM, To Err Is Human, 1999)

• Only 55% of patients receive recommended care (McGlynn, New England Journal of Medicine, 2003)

• Poor quality costs $17-$29B/year

Attributes of quality care(Institute of Medicine, Crossing the Quality Chasm, 2001)

Safe - avoid harm or injuries from care intended to help

Timely - no unnecessary waits

Effective - evidence based treatments and technology

Efficient - not wasteful

Equitable - same for all regardless of gender, race, ethnicity, age

Patient-Centered - responsive to preferences, needs and values

Why isn’t quality better?• Health care complex, poorly organized• Inadequate information infrastructure• “Toxic” payment system – rewards

unrelated to quality

The case for addressing quality and patient safety

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• Ensuring Affordability• Raising the Bar

– Bridges to Excellence (BTE)– Patient Safety Centers (PSC)– Intensive Care Initiatives (ICU)– Health Information Technology Initiatives (HIT)

• Closing the Gaps– Cardiovascular disease in African Americans– Diabetes in Hispanics– Cervical cancer in Asian women

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Cultural Diversity Training

Do you know me?

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Barriers and ChallengesContributors to health disparities

High rates of poverty Unemployment Uninsured Access to care Low primary and specialty care rates Critical shortages of physician and medical providers Lack of EMR Coordination/fragmentation of Care

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Removing Barriers

• Adapt IOM recommendations to reduce health disparities Develop collaborative partnerships Private and public sector, general public and key stakeholders work together Increase awareness of disparities Increase health care provider awareness Race and ethnicity data collection

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Prevention“Keeping the healthy, healthy.”

My Care First

Options

Health Education

MyHealthProfile

Lifestyle Management

Healthy Lifestyle Coaching

Workplace Solutions

Utilization Management“Right care. Right time. Right place.”

Hospital Pre-Auth

Discharge planning, concurrent review

Networks Mgmt.

Pharmacy Mgmt.

Disease Management“Smart choices for healthy living.”

Asthma

Diabetes

CHF/CAD

COPD

* Other Options Available

Case Management“When care is needed most.”

Assist member in navigating complex health condition/ experience

Great Beginnings

CareEssentials 17

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The Case for Closing the Gaps

CareFirst Mission

Increasing Diversity in CareFirst Region

National Concerns - IOM Report

Health Issues and Disparities

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Closing the GapsHow CareFirst can be a part of the solution

CareFirst has partnered with University of Maryland School of Medicine to provide blood pressure screening and cardiovascular risk factor awareness to African Americans through a community-based program in barber shops and hair salons in BaltimoreProgram launched - September 2005

CareFirst has partnered with Boat People S.O.S. to increase awareness and improve screening rates for cervical cancer among Vietnamese women. Program launched - September 2005

CareFirst has partnered with La Clinica del Pueblo (a D.C. based clinic) in a three year project to improve the care for diabetes in the Latino population. Program launched - April 2005

Diabetes in the Latino Population

Cervical Cancer in Vietnamese women

Cardiovascular Disease in African

Americans

CareFirst partnered with Manhattan Cross Cultural Group to provide cultural competency training to internal staff clinicians. Program launched - Dec. 2005

Clinician cultural Training