California Department of Public Health: Portrait of Promise – California Statewide Plan to Promote Health and Mental Health Equity

The California Department of Public Health’s Office of Health Equity has released its statewide plan to promote health and mental health equity.  The plan is the first demographic report and statewide strategic plan from the OHE since it was established in 2012. It presents evidence on the root causes of health inequities and offers strategies on how to address them.  For example:

  • almost one in four children in California lives in poverty, which is one factor that negatively impacts health
  • compared with the salaries paid to men, women still make less for the same work
  • one in five women in California has experienced physical or sexual violence by her partner
  • although death rates from stroke have declined in almost all racial and ethnic groups, the rate among African Americans remains about 50 percent higher than among some other racial or ethnic groups, mirroring similar disparities in related risks for high blood pressure, high cholesterol, tobacco use, and obesity
  • African American families are twice as likely as White families to suffer the loss of an infant
  • urban African American and Latino children are two to six times more likely to die from asthma than are White children
  • the prevalence of diabetes is two and a half times as high among Hawaiian/Pacific Islanders as among Whites
  • lesbian, gay, bisexual, transgender, queer and questioning (LGBTQQ) youths attempt and complete suicide more often than their straight peers

The report also highlights the impacts of the social determinants of health:

  • 61% of Latino children and 51% of African American children are not in pre-school
  • only 31% of American Indian/Alaska Native, 33% of Latino, 34% of African American, and 40% of Native Hawaiian/Pacific Islander third graders are reading at or above their grade level
  • over 57% of African American renters, over 55% of Latino renters, and over 52% of American Indian/Alaska Native renters spend over 30% of their income on housing
  • over 45% of California’s low-income African Americans, Latinos, and American Indians/Alaska Natives are unable to afford enough food

The strategic plan has three goals, with implementation strategies for health partners, the health field, and communities:

  • through assessment, yield knowledge of the problems and the possibilities
  • through communication, foster a shared understanding
  • through infrastructure development, empower residents and their institutions to act effectively.

Link to Original Source

Posted in Health Care Disparities, Health Care Disparities: Stakeholders Engaged, Health Care Disparities: The Evidence of Disparities, Health Status Disparities, Healthy Neighborhoods and Communities, Lesbian, Gay, Bisexual and Transgender Health, Prevention, Social Determinants of Health | Leave a comment

Asian and Pacific Islander American Health Forum: Immigrant Outreach – Applying Health Care Enrollment Best Practices to Deferred Action

This report from the Asian and Pacific American Health Forum describes how the lessons learned and best practices identified in conducting outreach to, and assisting immigrants, especially Asian Americans and Pacific Islanders, enroll in health care insurance through the health insurance marketplaces established by the Affordable Care Act, might be applied to outreach and enrollment for Deferred Action programs with the U.S. Citizenship and Immigration Services (USCIS).  Although President Obama’s executive actions to expand the Deferred Action for Childhood Arrivals (DACA) Program and create a Deferred Action for Parents of Americans (DAPA) Program are currently on hold while being challenged in federal court, this report provides valuable guidance to community-based organizations and others anticipating the eventual implementation of those programs.

Key informants identified the following barriers to DACA applications for Asian Americans and Pacific Islanders, many of which occurred simultaneously, and were responsible for the low rates of DACA applications from Asian Americans and Pacific Islanders:

  • Feelings of shame, fear, and guilt
  • Language barriers for some DACA-eligible youth and parents of DACA-eligible individuals
  • Confusion and misinformation about the DACA program and application process
  • Lack of resources for community-based organizations to adequately conduct outreach and provide assistance

Given the demographic overlap, similar messaging challenges, and fears, supporting enrollment in health insurance under the Affordable Care Act offers a number of lessons that can be adapted to promoting Asian American and Pacific Islander participation in the Deferred Action programs. They include:

  • Engage Asian American and Pacific Islander community-based organizations
  • Build partnerships with faith-based organizations, schools, small businesses, ethnic media
  • Address language and cultural barriers
  • Champion the voices of Asian Americans and Pacific Islanders eligible and impacted by these programs

Link to Original Source

Posted in Asian American, Native Hawaiian and Pacific Islander Health, Health Care Reform, Immigrant and Refugee Health | Leave a comment

Centers for Medicare and Medicaid Services: Medicare and Pioneer ACOs Report Results

The Centers for Medicare and Medicaid Services (CMS) has reported the most recent quality and shared savings results from the Medicare Shared Savings Program Accountable Care Organizations (ACOs) established by the Affordable Care Act, as well as the 20 Pioneer ACOs established by CMS through the Center for Medicare and Medicaid Innovation.  Since passage of the Affordable Care Act, more than 420 Medicare Shared Savings Programs ACOs have been established, serving more than 7.8 million Americans with fee-for-service Medicare as of January 1, 2015.

The Medicare Shared Savings Program ACOs that reported quality measures in 2013 and 2014 improved on 27 of 33 quality measures.  Meanwhile, in their third performance year, Pioneer ACOs showed improvements in 28 of 33 quality measures, and experienced average improvements of 3.6% across all quality measures.

According to CMS, 92 Medicare Shared Savings Program ACOs  earned performance payments of more than $341 million as their share of program savings. An additional 89 ACOs reduced health care costs compared to their benchmark, but did not qualify for shared savings, as they did not meet the minimum savings threshold.  ACOs with more experience in the program were more likely to generate shared savings.  Among ACOs that entered the program in 2012, 37 percent generated shared savings, compared to 27 percent of those that entered in 2013, and 19 percent of those that entered in 2014.

An accompanying fact sheet reports that 11 of the remaining 20 Pioneer ACOs qualified for shared savings payments of $82 million.  4 other Pioneer ACOs reduced their health care costs but did not qualify for shared savings.  The remaining 5 Pioneer ACOs had increased health care costs, with 3 having to pay CMS penalties totaling $9 million for CMS’ losses/increased costs.

These results remain encouraging overall but reinforce that quality improvements and shared savings continue to take significant time and effort to achieve and sustain, and are not uniform or automatic, even when there are organizational infrastructures such as ACOs created to drive forward those improvements and savings.  The increase, rather than decrease, in health care costs experienced by a significant number of the remaining Pioneer ACOs may mean that model will not continue very long, and be transitioned into the Medicare Shared Savings Program under new rules proposed in late 2014, expected to be finalized this year.

Posted in Health Care Reform, Health Care Reform: Accountable Care Organizations | Leave a comment

Agency for Healthcare Research and Quality: 2014 National Healthcare Quality and Disparities Report

This 2014 report from the Agency for Healthcare Research and Quality consolidates the annual National Healthcare Quality Report and National Healthcare Disparities Report. These reports to Congress are mandated by the Healthcare Research and Quality Act of 1999 (P.L. 106-129).  The consolidated report highlights the importance of examining quality and disparities together to gain a complete picture of health care. The report provides a comprehensive overview of the quality of health care received by the general U.S. population and disparities in care experienced by different racial, ethnic, and socioeconomic groups. The report is based on more than 250 measures of quality and disparities covering a broad array of health care services and settings.  This shorter, consolidated report only provides summary and illustrative measures rather than providing detailed measures as in prior years’ reports.  Additional data are available in chartbooks.

The report and supporting chartbooks are further integrated with the National Quality Strategy (NQS). The NQS has three overarching aims that support HHS’s delivery system reform initiatives to achieve better care, smarter spending, and healthier people through incentives, information, and the way care is delivered. These aims are used to guide and assess local, state, and national efforts to improve health and the quality of health care.

The report highlights that access improved:

  • After years without improvement, the rate of uninsurance among adults ages 18-64 decreased substantially during the first half of 2014.
  • Through 2012, improvement was observed across a broad spectrum of access measures among children.

Quality improved for most NQS priorities:

  • Patient Safety improved, led by a 17% reduction in rates of hospital-acquired conditions between 2010 and 2013, with 1.3 million fewer harms to patients, an estimated 50,000 lives saved, and $12 billion in cost savings.
  • Person-Centered Care improved, with large gains in patient-provider communication.
  • Many Effective Treatment measures, including several measures of pneumonia care in hospitals publicly reported by the Centers for Medicare & Medicaid Services (CMS), achieved such high levels of performance that continued reporting is unnecessary.
  • Healthy Living improved, led by doubling of selected adolescent immunization rates from 2008 to 2012.

Few disparities were eliminated:

  • People in poor households generally experienced less access and poorer quality.
  • Parallel gains in access and quality across groups led to persistence of most disparities.
  • At the same time, several racial and ethnic disparities in rates of childhood immunization and rates of adverse events associated with procedures were eliminated, showing that elimination is possible.

Many challenges in improving quality and reducing disparities remain:

  • Performance on many measures of quality remains far from optimal. For example, only half of people with high blood pressure have it controlled. On average, across a broad range of measures, recommended care is delivered only 70% of the time.
  • As noted above, disparities in quality and outcomes by income and race and ethnicity are large and persistent, and were not, through 2012, improving substantially.
  • Some disparities related to hospice care and chronic disease management grew larger.
  • Data and measures need to be improved to provide more complete assessments of two NQS priorities, Care Coordination and Care Affordability, and of disparities among smaller groups, such as Native Hawaiians, people of multiple races, and people who are lesbian, gay, bisexual, or transgender.

Link to Original Source

Posted in Asian American, Native Hawaiian and Pacific Islander Health, Health Care Disparities, Health Care Disparities: The Evidence of Disparities, Lesbian, Gay, Bisexual and Transgender Health | Leave a comment

Agency for Healthcare Research and Quality: Health Literacy Universal Precautions Toolkit

This is the updated second edition of the Agency for Healthcare Research and Quality’s Health Literacy Universal Precautions Toolkit. Health literacy universal precautions are the steps that health care providers take when they assume that all patients may have difficulty comprehending health information and accessing health services. Experts recommend assuming that everyone may have difficulty understanding, and creating an environment where all patients can thrive. Only 12 percent of U.S. adults have the health literacy skills needed to manage the demands of our complex health care system, and even these individuals’ ability to absorb and use health information can be compromised by stress or illness. Like with blood safety, universal precautions should be taken to address health literacy because we can’t know which patients are challenged by health care information and tasks at any given time. Health literacy universal precautions are aimed at:

  • Simplifying communication with and confirming comprehension for all patients, so that the risk of miscommunication is minimized.
  • Making the office environment and health care system easier to navigate.
  • Supporting patients’ efforts to improve their health.

The toolkit includes 21 Tools (3-5 pages each) that address improving:

  • Spoken communication.
  • Written communication.
  • Self-management and empowerment.
  • Supportive systems.

Link to Original Source

The AHRQ website has additional materials, including a Powerpoint presentation with speaker’s notes that can be used for training presentations.


Posted in Patient-Centeredness | Leave a comment

Center for Medicare and Medicaid Services: Medicare Health Outcomes Survey

The Center for Medicare and Medicaid Services requires Medicare managed care plans (Medicare Advantage) to assess certain health outcomes of their member Medicare beneficiaries.  The Health Outcomes Survey (HOS) is used to survey a random sample of 1,200 Medicare beneficiaries from each Medicare Advantage organization annually.  The surveyed beneficiaries are surveyed again after two years.  The HOS uses patient-reported outcome (PRO) measures.  Annual versions of the survey instrument are available online.

Four HOS measures (two functional health measures and two HEDIS Effectiveness of Care measures) are currently included in the annual Medicare Part C Star Ratings (a fifth measure, improving bladder control, is under revision):

  • Improving or maintaining physical health (VR-12)
  • Improving or maintaining mental health (VR-12)
  • Monitoring physical activity (HEDIS)
  • Reducing the risk of falling (HEDIS)

The functional health measures are derived from the Veterans RAND 12-Item Health Survey (VR-12) portion of the HOS, which serves as the core measure for the physical component summary and mental component summary scores.  The Healthcare Effectiveness and Data and Information Set (HEDIS) measures are maintained by the National Committee for Quality Assurance (NCQA).

CMS currently contracts with NCQA to support the standardized administration of the HOS and HOS-Modified surveys, including the selection and training of the independent survey vendors. Medicare Advantage Organizations (MAOs) and Program of All-Inclusive Care for the Elderly (PACE) plans contract with the survey vendors to administer the surveys.

Here is the NCQA’s technical specifications for the 2015 HOS.

Link to Original Source

The technical specifications reference the availability of the HOS in Spanish and procedures for administering the HOS to individuals whose primary languages are either Spanish or Chinese.  It is not apparent what percentage of annual respondents actually respond in Spanish or Chinese.

Posted in Health Care Reform, Health Care Reform: Quality Improvement, Patient-Centeredness | Leave a comment

Consumer-Purchaser Alliance: Patient-Reported Outcomes

This action brief from the Consumer-Purchaser Alliance describes how patient-reported outcomes (PROs) are increasingly used to measure health care quality performance. While patient experience of care is one of the triple aims, we rarely, if ever, ask patients to report whether the care they received made a difference in their lives.

PROs refer to the changes in an individual’s physical and/or mental health status, including their ability to perform normal household functions and job duties unhampered by disability, resulting from medical treatments and procedures. They are typically measured using a standardized patient survey instrument, such as exist for asthma, depression, back pain, and many other conditions. These data are not collected in clinical practice on a wide scale in the United States. For patients, PRO results can lead to better informed decisions for treatment and selection of providers. For purchasers, PRO reporting could help to identify which providers deliver care that patients find most beneficial.

The action brief calls for the following actions:

  • Purchasers should build PROs into new value-based payment models.
  • Purchasers should require collection and reporting of PRO performance measures at the physician and hospital levels through accountable care organizations and/or in direct contracting.
  • Purchasers should encourage their employees to discuss their interest/need for PRO results with their physicians.
  • Purchasers should incorporate PROs into mandatory transparency requirements at the health plan and provider levels.
  • Consumers should ask their health plans and providers to give them PRO information.
  • Consumers should continue advocating within policy-making bodies for the inclusion of PROs in public accountability and public reporting programs.
  • Consumers and purchasers should insist that their providers use PRO surveys that are parsimonious and capture information that is meaningful to the patient.
  • Consumers and purchasers should advocate for providers to create electronic patient portals for patients to enter PRO data
  • Consumers and purchasers should advocate for wider adoption of measures that already exist and are being used in the field
  • Purchasers should urge their plans to help pay for provider collection of PROs and sharing the data to further development of PRO performance measures.

Link to Original Source


Posted in The iBau Blog | Leave a comment

Consumer-Purchaser Disclosure Project: Patient Charter for Physician Performance Measurement

This “patient charter” developed by the Consumer-Purchaser Disclosure Project (now the Consumer-Purchaser Alliance) describes a set of principles for measuring, reporting, and tiering physician quality performance from a patient/consumer perspective.  The charter has been endorsed by AARP, the National Partnership for Women & Families, AFL-CIO, Leapfrog Group, Pacific Business Group on Health, and National Business Coalition on Health. The principles are:

  1. Measures should be meaningful to consumers and reflect a diverse array of physician clinical activities.
  2. Physicians and physician organizations being measured should be actively involved.
  3. Measures and methodology should be transparent and valid.
  4. Measures should be based on national standards to the greatest extent possible.

The Consumer-Purchaser Alliance is a collaboration of leading consumer, employer, and labor groups working together to promote the use of performance measurement in health care to inform consumer choice, value-based purchasing, and payment.  The Alliance is funded by the Robert Wood Johnson Foundation, along with support from participating organizations.

Link to Original Source

Posted in Health Care Reform, Health Care Reform: Quality Improvement, Patient-Centeredness | Leave a comment

Consumer-Purchaser Alliance: Improving Health Care Through Transparency and Performance Measurement

The Consumer-Purchaser Alliance has published this “message handbook” to support health care improvement through transparency and performance measurement.  The publication includes communications tools and measures to support health care quality performance measurement generally, as well as specifically on accountability, cost and price transparency, avoidable readmissions, risk adjustment for sociodemographic variables, improving patient engagement and experience of care, patient-reported outcomes, patient safety, clinical data registries, and health information technology.

Link to Original Source

Posted in Health Care Reform, Health Care Reform: Quality Improvement | Leave a comment

Consumer-Purchaser Alliance: Ten Criteria for Meaningful and Useful Measures of Performance

The Consumer-Purchaser Alliance has published these criteria for evaluating measures of health care quality performance.  These criteria reflect the perspectives of those who receive and pay for care, and should be used to guide the development, endorsement, and use of performance measures.  These criteria are:

  1. Make consumer and purchaser needs a priority in performance measurement.
  2. Use direct feedback from patients and their families to measure performance.
  3. Build a comprehensive “dashboard” of measures that provides a complete picture of the care patients receive.
  4. Focus measurement on areas of care where the potential to improve health outcomes and increase the effectiveness and efficiency of care is greatest.
  5. Ensure that measures generate the most valuable information possible.
  6. Require that all patients fitting appropriate clinical criteria be included in the measure population.
  7. Assess whether treatment recommendations are followed.
  8. De-emphasize documentation (check-the-box) measures.
  9. Measure the performance of providers at all levels (e.g., individual physicians, medical groups, accountable care organizations).
  10. Collect performance measurement data efficiently.

Link to Original Source

Posted in Health Care Reform, Health Care Reform: Quality Improvement | Leave a comment