Understanding Health Care Reform and MassHealth Communities of Color

The MassachusettsHealth Disparities Council

Tom Dehner, Medicaid Director April 27, 2009

Overview

■ Current MassHealth race & ethnicity data

■ Impact of HCR

■ Efforts to increase race and ethnicity data collection

■ Acute hospital pay for performance measures on disparities

■ Next Steps

Current Data

Black not Hispanic9%

Hispanic14%

White not Hispanic39%

Other3%

No Answer34%

Black not Hispanic13%

Hispanic22%

White not Hispanic60%

Other5%

MassHealth Enrollment by Race Ethnicity, FY 2008

Includes "No Answer" Excludes "No Answer"

Race and Ethnicity Data Details

■ Data is primarily self-reported on application for coverage.– Data source is the MassHealth data

warehouse.■ “Other” Race/Ethnicity category adds Other,

Native American, Alaskan American, and Asian/Pacific Islander together.

■ The “MassHealth and Health Reform Programs” includes enrollment in MassHealth, CommCare and the Health Safety Net.

MassHealth and Health Reform Programs Enrollment by Race/Ethnicity , FY 2002- 2008

0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6

Average Daily Members (millions)

2002

2003

2004

2005

2006

2007

2008

Fis

cal Y

ear

Black not Hispanic Hispanic White not Hispanic Other No Answer

Changes Over Time

■ From FY2004, before Health Reform, to FY 2008 for MassHealth enrollment only:

– The “Other” category grew the most, led by 83% increase of Asian Americans.

– Hispanic grew 47%

– Black grew 40%

– White grew 18%

■ From FY2004 to present, for all Health Care Reform programs, there has been significant growth in the “not answer” segment.

Efforts to Increase Race & Ethnicity Data Reporting

■ Systematic edits in the application process are being made to ensure that new members or members re-determining eligibility are reminded to provide race and ethnicity data.

■ MassHealth is working with the Common Client Index Project to develop strategies for race and ethnicity data sharing across EOHHS agencies that serve MassHealth members.

■ Strategies to work with the provider community to increase race and ethnicity data collection are being considered.

Acute Hospital P4P Health Disparities Measurement

■ Structural measures account for organizational factors that affect healthcare disparities.

■ Clinical measures assess disparities by clinical quality indicators.

■ Disparities measures data collection began RY08.

Health Disparities Measure Development Process

Conduct Environmental Scan

Review National/State Health Disparities Initiatives• Review medical literature on factors contributing to disparities• Review literature on system factors and approaches to reducing

disparities (IOM, JCAHO, CMS, NCQA, NQF, Baldridge)• Review literature on cultural competence/CLAS measures to identify

consensus on measure constructs and quality scoring models (Baldridge, NCQA, Medicare)

Consult with Stakeholder Industry Leaders• AHRQ Office Clinical Quality (Nat’l Health Disparities Report Methods)

• Federal DHHS Office Minority Health• National Quality Forum – Cultural Competence Measures Project• Boston Public Health Commission Hospital Disparities Workgroup• MA Medicaid Policy Institute Disparities Roundtable• MA Commercial Payer Initiatives: BCBSMA, HPHC, Tufts, GIC• MassHealth Hospital Quality Advisory Committee (HQAC)

Health Disparities Measurement & Incentive Strategy

Strategy RFA08 (Yr.1)HD-1 Structural Measure

RFA09 (Yr. 2)HD-2 Clinical Measures

Phase-in Approach

■ Reward Hospitals to improve organizational factors that support patient care delivery to reduce racial/ethnic health disparities.

Reward Hospitals to report data by Race/Ethnicity & reduce disparities in clinical quality measures

Performance Measure ■ Require Hospitals to implement a minimum set of CLAS standards regardless of patient R/E/L mix served.

■ CLAS Measure (CCOSA composite)

Clinical Quality Measures: ■ Maternity/Newborn indicators■ Pediatric Asthma indicators■ Pneumonia indicators■ Surgical Infxn Prevention indicators

Performance Assessment Method

■ CLAS Validation Rate■ CLAS Best Practice Rating■ CLAS Measure Score

Data Validation Rate (RY09)Clinical Disparity Measure Score (RY2010)

Bonus Payment Approach

■ Earn payments for meeting performance thresholds on organizational factors (implementing CLAS).

■ Earn payments for meeting performance thresholds on clinical disparities measures

RY08 CLAS Measure Rate Results

74%79%

73%

79%82%

86%

70%

76%76%

81%

0%

20%

40%

60%

80%

100%

Ho

spita

l Mea

sure

Rat

e

HD1-Governance

Practices

HD1-Admin/MgtPractices

HD1-ServicePractices

HD1-Cust ReltnPractices

HD-1 TotalMeasure Rate

Hospital Practices Implemented by Organizational Core Function

RY07 Ave RY08 Ave

Next Steps

■ Improved reporting of race and ethnicity data is essential.

■ MassHealth is committed to increasing the work with our provider and member communities to improve access and delivery of quality care.

■ Disparities measured by claims data versus survey data create different challenges.

Fee-For-Service Members

68,800

65,800

196,200

55,700

1,100

MassHealth FFS Only (excludes emergencyservices only population)

Comprehensive Private Insurance withMassHealth Service Wrap (incl. PremiumAssistance and ESI)

Medicare with MassHealth Service Wrap

MassHealth Emergency Services Only(Limited)

EAEDC