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Equity of Care Hospital Perspective on Reducing Health Care Disparities Providing Culturally and Linguistically Appropriate Patient Centered Care Marcos Pesquera, RPh, MPH Executive Director

Center on Health Disparities at Adventist HealthCare Faith-based Non-profit health system Mission to promote health equity within our facilities and in the community Bridge partnerships to eliminate health disparities Promote the health of our community

Today s Discussion 1 Center on Health Disparities Development 2 Strategies and programs to address Healthcare Disparities 3 Re-alignment of resources to meet new requirements and standards

Center on Health Disparities Structure Blue Ribbon Panel Recommendations Training & Education Health Care Services Research Institute Improving patient-provider relationships & trust to achieve better outcomes Expanding services to underserved communities Transforming evidencedbased research into practice Improving the Health of Our Communities

Changing Demographics in Maryland: Census 2010 Findings Census 2010 population statistics Baltimore County Montgomery County Prince George s County Maryland White 65.4% 43.6% 26.6% 61.1% Black or African American 26.8% 18.2% 65.4% 30.0% Asian 5.2% 14.4% 4.3% 5.8% Latino 4.4% 17.5% 15.2% 8.4% Foreign Born* 10.7% 31.4% 19.8% 13.5% Language other* than English spoken at home 12.6% 38.1% 19.8% 16.2% 2010 Census data, Baltimore, Montgomery, & Prince George s Counties Population Statistics: Race/Ethnicity, Language, & Foreign Born Status

Agenda 1 Center on Health Disparities Development 2 Strategies and programs to address Healthcare Disparities

What is Cultural Competence? Practitioner s Guide The delivery of health care services that acknowledges and understands cultural diversity in the clinical setting, respects patients health beliefs and practices and values cross-cultural communication. (Kaiser Permanente) Organizational Application A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations. (Health Resources and Services Administration)

Strategies and programs to address Healthcare Disparities A. Cultural Competence Organizational Assessment B. Increase Awareness through local disparities data and provider training C. Health Equity Report D. State and County Involvement

A. How do you achieve cultural competence? Organizational Assessment Overview* Organizational Values Governance Planning, Monitoring & Evaluation Communication Staff Development *Seven Domains from Health Resources and Services Administration Organizational Infrastructure Services & Interventions Culturally Competent Patient- Centered Care

Organizational Assessment Phases Step 1 Presentation to Leadership to solicit participation and engagement Step 2 Individual Leadership Interviews and Providers/ Staff Focus Groups Step 3 Community Interviews Step 4 Report Development and Recommendations Step 5 Develop Strategic Implementation Plan

B. Increase Awareness through local disparities data and provider training The Center on Health Disparities provides cultural competence training to clinical and non-clinical health care professionals and staff at Montgomery County health care organizations to improve provision of culturally appropriate care, increase awareness of racial and ethnic disparities in health care, eliminate cultural and linguistic barriers during clinical encounters, and improve quality of care. Module 1: Understanding Our Populations Module 2: Stereotypes, Biases and Assumptions Module 3: Skills and Resources for Providing Culturally Competent Care

Worlds Apart Language Culture Religion Family Dynamics

The Provider and Patient Interaction Past Experience Race, Culture, Education, Knowledge, Gender, Class Reality Filters Culture, Education, Knowledge, Gender, Class, Social Standing, Race, Assumptions Assumptions Perceived Reality Patient Behavior Provider Behavior Perceived Reality Dr. Judy Ann Bigby, Associate Professor, Harvard Medical School Director, Office of Women Family and Community Programs, Brigham and Women s Hospital, Boston, MA.

Cross-Cultural Communication Model Listen with sympathy and understanding to the person s perception of the problem. Explain your perceptions of the problem. Acknowledge and discuss the differences and similarities between the two perspectives. Recommend an action plan. Negotiate a mutual agreement on the action plan. Source: Berlin & Fowkes (1983)

Dual-Role Qualified Bilingual Staff Program The purpose of the Qualified Bilingual Staff or QBS Training is to train and certify bilingual staff properly interpret for patients with limited or no English proficiency in medical settings. (NCQA Award: CLAS Best Practice) Three-day training on language interpretation skills Language assessment for certification Training Modules: Ethics of Interpreting Legal and Regulatory Requirements Medical Terminology Cultural Competency Diversity Modes of Interpretation Managing the Session Transparency in a Patient-Provider Relationship Cultural Broker Role

C. Adventist HealthCare Health Equity Report 1. Snapshot of Diversity: Patient population demographics 2. Hospital Settings: Where we see our patients 3. Cancer Diagnoses by Race/Ethnicity, Age, and Type 4. Inpatient Clinical Quality Indicators 5. Hospital Readmission Rates 6. Patient Experience

Objectives 1 Center on Health Disparities Development 2 Strategies and programs to address Healthcare Disparities 3 Re-alignment of resources to meet new requirements and standards

Standards

D. Federal, State and County Involvement National/Federal Standards CLAS, Joint Commission, ACA, NQF MHA-QBS Partnership Maryland Healthcare Quality and Cost Council Health Enterprise Zones CCC Requirements Healthcare Services Cost Review Commission Demographic Data Collection 20

Realignment of Community Benefit Interventions with Care Continuum *Center on Health Disparities /Health and Wellness/ Mission Integration *CHNA Development *CHNA Implementation Plan *Local & hospital data *Wellness Outreach *Cultural Competence *Community Partnership Fund aligned *Care Transition *Places of Worship *Local Health Department *Partnerships With Non Profits and Safety Net *Program results, Evaluation and Reporting *Population Health

Thank You! Contact Information: Marcos Pesquera, Executive Director Center for Health Equity and Wellness E-mail: mpesquer@adventisthealthcare.com Like Us on Facebook: http://www.facebook.com/healthdisparities Visit Us on the Web: www.adventisthealthcare.com/disparities

Diversity and Inclusion Work in Tennessee s Hospitals November 5, 2013

THA Background Ongoing diversity efforts for nearly 20 years Agenda 21 Internship Program for minority students Council on Diversity - Chair sits on THA Board Actively seek diversity for THA board and committees Bi-annual diversity survey of hospital boards and C-suites AHA partnership for governance diversity program held in Nashville in late 2011

Equity of Care: National Call to Action THA board adopted in 2011 Endorsed by: THA Council on Diversity THA Trustee Council

Change in Hispanic Population in Tennessee from 2000-2010 % Change 2000-2010 # of counties Overall TN change: 134% Loss 3 0-49% 9 50-99% 40 100-149% 23 150-199% 12 200%+ 8

Lack of Good Data About Who We Serve Race Categories - 2010 Type Category ED % Inpatient % Total Coded 2610226 91% 814685 92% 3424911 Missing 15 0% 6 0% 21 Other 61025 2% 18079 2% 79104 Unknown 181737 6% 55292 6% 237029 Total 2853003 100% 888062 100% 3741065 Race Reported unknown or other represents more than 316,000 patients. Ethnicity Codes - 2010 Ethnicity Unknown is nearly 800,000 patients. Type Code ED % Inpatient % Total Coded 2249316 79% 692881 78% 2942197 Missing 67 0% 5 0% 72 Unknown 603620 21% 195176 22% 798796 Total 2853003 100% 888062 100% 3741065 Current data parameters allow for limited information. Identifying primary language is key to knowing population.

Disparities Solutions Project THA contracted with a diversity and inclusion consultant to build a plan suitable for hospitals Identified a two-pronged approach Data collection Community engagement Launched two pilot programs to introduce and develop the DSP

Disparities Solutions Project Pilot groups officially launched in June 2013 Working as a collaborative with support from THA staff and consultant Regular conference calls and webinars Two in-person meetings as a full group 12-18 month window for initial efforts Focus on sustainability and recruitment of additional hospitals after year one

DSP: Challenges Making the business case Yet another project/program On-going/outside funding

DSP: Lessons Learned THA s own D & I journey Community Engagement model works Development of hospital councils/committees

DSP: Opportunities and Outlook Data collection goal: Jan 2015 Many hospitals already collect language Early successes with community engagement hospitals Partnerships to sustain the work THA HEN contract for disparities and readmissions Grants and other outside funding

THA Disparities Initiative Impact HCAHPS and Patient Satisfaction Scores Readmissions Value-Based Purchasing Accountable Care Organizations Knowing your community, patients and their needs ensures success. Community Needs Assessment Population Health and Wellness

Equity of Care: Care Disparity and Diversity Efforts in Maryland November 5, 2013 Carmela Coyle, President & CEO Maryland Hospital Association

Overview Maryland Hospital Activities - Data Collection and Use - Cultural Competency - Diversity in Leadership - Women and Minority-Owned Business Initiative Why Do This?

National Call to Action

Data Collection and Cultural Competency MHA/State Rate Setting Commission: - Hospital Race and Ethnicity Disparities Workgroup - Require all OMB race categories collected MHA/Adventist Center for Health Disparities: - Statewide hospital meeting on accurate, consistent data collection - 3 regional sessions on how to collect data - Offering Qualified Bilingual Staff Program MHA/Office of Minority Health & Health Disparities - Implement training on CLAS standards

Diversity in Leadership MHA partnered with the American Hospital Association Recruited individuals from diverse backgrounds Hosted leadership/trustee training opportunity - Center for Healthcare Governance - Minority Trustee Candidate Registry

Women and Minority-Owned Business MHA-led effort Increase the volume of goods and services purchased by hospitals from women and minorityowned businesses Quantify across the state and report Creates community connections Can aid efforts to increase the diversity of hospital boards

Why? Communities are changing People are watching Care is better Success in a new delivery system demands it

Why? Communities are changing Rapidly changing demographics in Maryland Widening educational gaps Creates new and greater challenges for increasing diversity in our: o Workforce o Executive leadership o Boardrooms

Why? People are watching Hospitals community mission Not-for-profit status Largest private sector employer o Labor relations Good citizens o Political champions o Best defense is a good offense

Why? Better for patient care Better quality Lower cost Higher patient satisfaction Higher employee satisfaction

Why? Required to succeed in managing the health of populations The Maryland example: o Only state that doesn t follow Medicare hospital payment rules o Prices set by the state All-payer system o 40 years old applied to CMS to modernize o Likely to be approved before year end: o Statewide spending cap and savings goal o Hospital-specific global budgets o Annual quality metric goals

Maryland s Medicare Waiver Game changer for disparities, diversity New payment mechanisms (spending caps/global budgets) Changes the incentives - Rewards the right things - Keep patients out of the hospital - Manage health of the community Makes the business case - Know our patients - Tailor our strategies - Serve our customers

Equity of Care: Care Disparity and Diversity Efforts in Maryland November 5, 2013 Carmela Coyle, President & CEO Maryland Hospital Association

Q & A