#123forEQUITY CAMPAIGN

#123forEQUITY CAMPAIGN Prepared by: Sharon C. Allen, MBA Senior Executive Director of Operations Institute for Diversity and Equity of Care American Hospital Association Date: April 1, 2016

PRESENTATION OVERVIEW Race and Ethnicity in the U.S. Diversity and Disparities Defined National Call to Action to Eliminate Health Care Disparities #123forEquity Pledge Update Addressing Questions and Concerns 2

DIVERSITY IS A REALITY IN THE U.S.

DIVERSITY IS A REALITY IN THE U.S. 1980 U.S. Population by Race/Ethnicity Asian 1.5% Other, 1.0% 2014 U.S. Population by Race/Ethnicity Other, 1.9% Projected 2060 U.S. Population by Race/Ethnicity Other, 1.8% Hispani Black c, 6.4% 11.7% White 83.1% Asian Hispani 5.4% c, 17.4% Black 13.2% White 62.1% Hispan ic, 28.6% Asian 11.7% Black 14.3% White 43.6% The way it used to be, health care concentrated on homogeneous population. Today s population much more diverse, the need for equity of care more important. U.S. majority population comprises majority people of color, equity of care is an absolute. 4

DISPARITIES AND DIVERSITY DEFINED Health Disparities Can be defined as inequalities that exist when members of certain population groups do not benefit from the same health status as other groups. Evolving definition of Diversity Inclusive of disability, race, ethnicity, language, gender, sexual orientation, veteran and socioeconomic status. 5

WHY ELIMINATE DISPARITIES, INCREASE DIVERSITY? Right thing to do Direct link to the Triple Aim, Performance Improvement, CHNA, CLAS, Meaningful Use, and other federal and state requirements Significant vulnerability for the field Meet changing needs and expectations of patients and communities 6

THE GOAL: THE TRIPLE AIM Population Health Experience of Care Per Capita Cost Health equity is the target. 7

DIVERSITY AND DISPARITIES BENCHMARKING SURVEY Produced by Health Research and Educational Trust (HRET) and the Institute for Diversity (the Institute) subsidiaries of the American Hospital Association (AHA) A national survey of hospitals to determine actions that hospitals are taking to reduce health care disparities and promote diversity in leadership and governance. Results offer a snapshot of some common strategies used to improve the quality of patient care regardless of race or ethnicity Administered in 2011, 2013, and 2015 National Call to Action Partners 8

AHA Goals BENCHMARKING SURVEY RESULTS AND PROJECTIONS Milestones by Year 2011 (Baseline) 2013 (Progress Data) Collection and Use of REaL Data Cultural Competency Training Increasing Diversity 18% 81% Governance 14% Leadership 11% 19.4% 86.4% Governance 14% Leadership 12% 2015 Goal 25% 90% Governance 16% Leadership 13% 2017 Goal 50% 95% Governance 18% Leadership 15% 2020 Goal 75% 100% Governance 20% Leadership 17% 9

NATIONAL CALL TO ACTION PARTNERS Started in 2011 As determined by the partners: Some progress reported from benchmarking surveys, more work needs to be done Partners wanted to move the needle to accelerate progress AHA created a new national strategy to accelerate progress The #123ForEquity Pledge Campaign was launched National Call to Action Partners 10

NATIONAL CALL TO ACTION/EOC GOALS 1. Increase collection and use of race, ethnicity and language (REaL) preference data 2. Increase cultural competency training 3. Increase diversity in leadership and governance 11

#123forEquity Pledge to Act Step to Participate 1. SIGN THE PLEDGE Pledge to achieve the three areas of the National Call to Action. 2. TAKE ACTION Implement strategies that are reflected in your strategic plan and supported by your board and leadership. Provide updates on progress to the AHA and your board in order to track progress nationally. 3. TELL OTHERS Achieve the goals and be recognized. Tell your story and share your learnings with others in conference calls and other educational venues, including social media to accelerate progress 12

OUR PLEDGE TO ACT REQUEST Address the following areas in the next 12 months. Below is a suggested timeline for addressing each area, but it can be modified based on your needs: By End of Month 1 By the end of Month 3 By the end of Month 6 By the end of Month 9 (from the date of your start) Choose a quality measure to stratify by race, ethnicity or language preference or other socio-demographic variables (such as income, disability status, veteran status, sexual orientation and gender, or other) that are important to your community's health. Quality measures to stratify could include readmissions or other core measures Determine if a health care disparity exists in this quality measure. If yes, design a plan to address this gap Provide cultural competency training for all staff or develop a plan to ensure your staff receives cultural competency training. Have a dialogue with your board and leadership team on how you reflect the community you serve, and what actions can be taken to address any gaps if the board and leadership do not reflect the community you serve. 13

Pledge online at www.equityofcare.org Suggested timeline for taking action within the next 12 months 14

#123FOREQUITY PLEDGE TO ACT PROGRESS 2016 Goals: 1,000 by Mar. 31 2,000 by Dec. 31 100% of SHAs pledged 10 case studies report successful goals 15

EQUITY OF CARE RESOURCES: TOOLKIT This toolkit is a user-friendly how-to guide to help accelerate the elimination of health care disparities and ensure our leadership teams and board members reflect the communities we serve. www.equityofcare.org 16

EQUITY OF CARE RESOURCES: VIDEOS Listen to videos from AHA President and CEO Rick Pollack on the importance of taking the pledge and hear from hospital CEOs champions who are committed to equity of care for all people. Rick Pollack, President and CEO American Hospital Association Scott Malaney, President CEO Blanchard Valley Health System Rick de Filippi, Community Health Advisory Council Cambridge Health Alliance Craig A. Becker, President Tennessee Hospital Association Chandler Ralph, CEO Adirondack Medical Center at Brim Healthcare Bruce Bailey, President & CEO Tidelands Health 17

FREQUENTLY ASKED QUESTIONS Key questions with answers that provide more insight and understanding of the #123forEquity campaign. 18

FREQUENTLY ASKED QUESTIONS What is the timeframe to do this work? The timeframe of this work is 12 months from the time the pledge is signed. AHA suggests a timeline for action steps to begin meeting each National Call to Action goal area, but it can be modified based on the needs of the hospital. The pledge form gives details of the timelines and action steps.

FREQUENTLY ASKED QUESTIONS I don t have a lot of racial and ethnic diversity in my community, so what does that mean for the pledge? Start with race and ethnicity but every community is different so you can also stratify data by language preference or other sociodemographic variables (such as income, disability status, veteran status, sexual orientation and gender, or other) that are important to your community's health. In addition to addressing disparities for people of color, you may identify other groups such as veterans, people with psychiatric disabilities, people living in poverty, the gay, lesbian and transgender population, and others who may be experiencing disparities in care and health. 20

FREQUENTLY ASKED QUESTIONS What are health disparities? Health disparities refer to gaps in the quality of health and health care across racial, ethnic and socioeconomic groups. Studies have demonstrated the multiple factors that contribute to health disparities 21

FREQUENTLY ASKED QUESTIONS How will my hospital data be kept confidential? All hospitals and endorsers/supporters that sign up for the pledge will be listed publicly on the campaign website at www.equityofcare.org. The progress data for each hospital is kept confidential and only reported in aggregate to the public. 22

FREQUENTLY ASKED QUESTIONS Can hospitals afford the added costs of this work? Associated with health care disparities are increased costs of care due to excessive testing, medical errors, increased length of stay and avoidable readmissions. Pay-for-performance contracts are beginning to include provisions to address racial and ethnic disparities. Between 2003 and 2006, 30.6% of direct medical expenditures for African Americans, Asians and Hispanics were excess costs due to health care disparities (Joint Center for Political and Economic Studies, 2009). Eliminating health care inequities associated with illness and premature death would reduce indirect costs by $1 trillion. Researchers estimate that eliminating disparities would reduce direct medical expenditures by as much as $229 billion. 23

FREQUENTLY ASKED QUESTIONS Is what we are doing to advocate for electronic health record system (EHR) standardization enabling providers to collect the information we are asking for? In some cases, yes. However, more needs to be done to advocate for EHR standardization to minimize cost to the providers and systematize the collection, stratification and use of patient data. Most systems today are or can be tailored to ask the standard questions the major race/ethnicity/language options. It is really up to the hospital to decide which of the categories to include based on their patient population and needs of the communities. A good reference is the HRET Disparities Toolkit at http://www.hretdisparities.org 24 24

FREQUENTLY ASKED QUESTIONS What do you mean by cultural competency training? How much? How to give? Cultural competence refers to an ability to interact effectively with people of different cultures, backgrounds and experiences. Cultural competence training should include four components: (a) Awareness of one's own cultural worldview (b) Attitude and biases toward cultural differences (c) Knowledge of different cultural practices and worldviews (d) Cross-cultural skills 25

FREQUENTLY ASKED QUESTIONS Why was cultural competency training to help providers treat people with disabilities not a part of the data collection and evaluation process for developing strategies? The AHA understands that other groups of people, such as those with disabilities, experience barriers to care. The AHA suggests that the cultural competency training should be tailored to your organization and patient population needs based on the data collected and analyzed to identify if gaps in care and health exist. The AHA would expect disabilities, including psychiatric disabilities, to be in many competency programs. 26

FREQUENTLY ASKED QUESTIONS How do we build a diverse leadership pipeline? 1. Develop a measurable and achievable goal for diversity in both top management and the board of trustees. 2. Set clear expectations for human resources and talent search firms to include at least two minority candidates interviewed for every top management position. 3. Create a mentoring program for management staff in which less experienced employees are formally paired with a senior staff person to develop professional networks and skills. 4. Identify local community stakeholders and internal people of color to help recruit qualified candidates from outside the company to fill upper-level positions. Other best practice strategies are available at www.diversityconnections.org. 27

FREQUENTLY ASKED QUESTIONS How can the board of trustees get involved? It can: Encourage and support the CEO and leadership to set clear performance goals to tie to these efforts. Ensure that the strategic plan and dashboards address and monitor progress on achieving the National Call to Action goals and other diversity and inclusion priorities. Make sure that the hospital participates in the AHA s Diversity and Disparities Benchmark Survey to establish an overall baseline and progress for the nation s hospitals while contributing to the improvements needed in health care 28

EQUITY OF CARE TEAM Tomás León, MBA President and CEO, Institute for Diversity of Health Management tleon@aha.org 312-422-2697 Sharon C. Allen, MBA Senior Executive Director of Operations Institute for Diversity and Equity of Care sallen@aha.org 312-422-3722 Gregg Valentine Executive Assistant Institute for Diversity gvalentine@aha.org 312-422-2630 29