Download Improve Quality (VALUE)

SC Executive Assistances in Health
Care Annual Meeting
Health Disparities, Health Equity
and Diversity in Health Care
Anton J. Gunn, MSW
Chief Diversity Officer
& Executive Director of
Community Health Innovation
Affordable Care Act:
Major Themes
1. Expanded Coverage (ACCESS)
2. New Consumer Protections and Choice
(VALUE)
3. Health Care More Affordable (LOWER COSTS)
4. Improve Quality (VALUE)
5. Improve Prevention and Wellness
(POPULATION HEALTH)
2
Implementation
2016
What Does It All Mean?
Expanded Insurance Coverage to 20 million people.
Delivery System Changes
› Expanding Primary Care
› More Care Integration
› Broadening Access
New & Different Patients (Changing Patient Mix)
3
Profile: The New Healthcare Consumer
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84% - 19-64 Years old… Average Age 35-40
48% Unmarried
52% Men
1 in 4 Speak a Language Other than English
77% High School Education or Less
80% Employed ( $23,994/single or $48,528 family of 4)
58% White, 11% Black and 25% Hispanic/Latino
39% - No usual source of care
37% - Gone more than 2 years with no check up
29% - No connection with delivery system at all
Source: Kaiser Family Foundation, 2011
Great Expectations
What do these new consumers expect?
What experiences have they had previously with care
delivery?
What are they going to see when they get care?
Who are they going to expect to see?
Does your organization meet those expectations?
ER (1994-2009)
Trapper John, M.D. (1978-1986)
Healthcare Reform
• Value driven by Patient Experience
• Patient Experience driven by Patient
Expectations
• Achieving value more complex due to
diversity of patient population
Healthcare Reform
Healthcare Executives Must Embrace
Leadership roles to:
 Improve Health of Population
 Improve Patient Experience
 Lower Costs
Triple Aim
Leadership Challenges
To ACHIEVING VALUE
• Giving power to patients, communities and families as
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partners in improving health and well-being
Resource allocation (how we invest)
Silos and Institutional/Professional boundaries
Financial and Fiscal Pressures
Welcoming systems change while continually pursuing
improved outcomes
Acknowledging that health care is a service industry
(Social Work as much as Medicine)
“Closing the Gap” on disparities in care
Institute of Medicine Report 2002
Institute of Medicine (IOM) on Disparities
People of Color receive lower-quality health care than
whites do, even when insurance status, income, age and
severity of conditions are comparable.
People of Color more likely to be treated with disrespect by
the health care system and more likely to believe that they
would receive better care if they were of a different race.
Major disparities found in many key diagnostic areas:
cardiovascular disease, cancer, stroke, kidney dialysis,
HIV/AIDS, asthma, diabetes, mental health, maternal and
child health.
Source: Unequal Treatment, Institute of Medicine, 2002
Institute of Medicine (IOM) on Disparities
CALL TO ACTION
• Increase the public and provider awareness of disparities
• Decrease fragmentation of care and change financial
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incentives to improve quality
Reduce barriers to care for people of color
Increase diversity of providers
Promote quality evidence based practice
Promote enforcement of civil rights
Source: Unequal Treatment, Institute of Medicine, 2002
13 Years Later: Much More Work To Do
AHRQ 2014 Report: Demonstrates that the Nation has
made clear progress in improving the health care delivery
system to achieve the triple aim but there is still more work
to do, specifically to address disparities in care.
› Access improved
› Quality improved for most National Quality Strategy
priorities
› Few disparities were eliminated
› Many challenges in improving quality and reducing
disparities remain
Source: National Disparities Report 2014, Agency for Healthcare Research & Quality
Disparities in Pain Management
Linked to Racial Bias
Researchers at the University of Virginia quizzed white medical
students and residents to see how many believed inaccurate and at
times "fantastical" differences between blacks and whites-- (e.g., black
people’s skin is thicker; black people’s blood coagulates more quickly)
They found that fully half thought at least one of the false statements
presented was possibly, probably or definitely true.
Black Americans are systematically undertreated for pain relative to
white Americans, likely due to both the over-prescription and over-use
of pain medications among white patients and the under-prescription
of pain medications for black patients.
Indeed, research has shown that black patients are undertreated for
pain not only relative to white patients, but relative to World Health
Organization guidelines.
Proceedings of the National Academy of Sciences, April 2016
Racial Disparities Cost U.S.
$57 Billion per Year
Racial health disparities in infant mortality,
chronic disease and many other metrics
cost the U.S. health system more than $57
billion a year, according to a report
authored by researchers from Johns
Hopkins University and the University of
Maryland.
Source: Joint Center for Political and Economic Studies (a Washington, D.C.
think-tank) September, 2009
Comparisons:
South Carolina & U.S.
Population
South
Carolina
Charleston
U.S.
People of Color
36%
31%
37%
Foreign Born
4.8%
4.2%
12.9%
Foreign
Language
at Home
(Age 5+)
6.8%
5.3%
20.7%
Notes: Source: U.S. Census Quick Facts. Racial statistics from 2010. Foreign born
statistics from 2009-2013. Language statistics from 2009-2013.
The Changing Demographics in America
US Population
2014
2060
% Change
People of Color
38%
56%
47%
Foreign Born
42M
78M
85%
Foreign
Language
at Home
(Age 5+)
21%
30%
43%
Notes: Source: U.S. Census Bureau, National Projections 2014.
How do we as health care leaders
meet these increasingly complex
challenges in our increasingly
complex organizations?
BLUE PRINT for Health Executives
 Diversity and Equity as a Leadership Competency
 Physician Engagement & Alignment
 Total Organizational Engagement
 Embrace Population Health Management
 Understand Value Advantage: High Reliability
High Reliability Organization
A high reliability organization (HRO)
is an organization that has succeeded in
avoiding catastrophes in an environment
where normal accidents can be
expected due to risk factors and
complexity.
High Reliability Principles
Patients
Families
DO NO
HARM
Visitors
Community
High Reliability Principles
Principles of Anticipation
Preoccupation with Failure
Commitment to Resilience
Reluctance to Oversimplify
Deference to Expertise
Sensitivity to Operations
Principles of Containment
High Reliability Principles
 Collect REaL (racial, ethnic, & language) data
 Understand global medicine
 Improve cultural competence of providers, staff and
leaders
 Diversify your clinical team to reflect patient population
 Address healthcare disparities
 Understand impact of implicit bias
High Reliability Principles
 Patient Experience/ Engagement/Patient-Centered Care
Work Effectively as a Team (interprofessionalism)
Know civil rights and ADA law
 Joint Commission Standards & Culturally &
Linguistically Appropriate Services (CLAS) Standards
 Using Interpretation Services Effectively and Consistently
Why Cultural Competence Matters…
• Reduction in Medical Errors and Legal Risks
• Quality of Care
• Patient Satisfaction/Engagement
• Positive Health Outcomes
• Reduction/Elimination of Racial and Ethnic
Health Disparities
Why Diversity & Inclusion Matters…
• To ensure equitable care is provided to all patients
• To create an environment where employees are included,
respected, and valued
• To empower a clinical workforce that breeds innovation
• To help build a better and stronger organization
• To engage the community in improving health outcomes
(population health)
Questions ????
Contact Information
Anton J. Gunn, M.S.W.
Executive Director of Community Health Innovation &
Chief Diversity Officer
843-792-2621
[email protected]
Twitter: @AntonJGunn
Instagram: @AntonJGunn