Intervening to Eliminate Disparities in Healthcare

Intervening to Eliminate Disparities in Healthcare Speakers: Joseph Betancourt, MD, MPH Founder and Director, The Disparities Solutions Center Senior Scientist, Mongan Institute for Health Policy Center at Massachusetts General Hospital Director for Multicultural Education, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School Berny Gould, RN, MNA Senior Director, Quality, Hospital Oversight and Equitable Care National Health Plan and Hospital Quality Kaiser Permanente Host: Boris Kalanj, MSW Director, Cultural Care and Experience, Hospital Quality Institute PFE and Disparities Leader, Health Services Advisory Group (HSAG) HIIN 1 Tuesday, June 5, 2018

HSAG HIIN 274 hospitals in 5 states HSAG in Partnership With HQI Disparities Impact/Action Identify gaps in the collection of Race, Ethnicity, Age, and Language (REAL) data at the point of care. Provide coaching and technical assistance to hospitals to reduce gaps. Measure and address disparities in care and readmission. 2

Disparities Webinar Series Date September 19, 2017 November 28, 2017 January 30, 2018 March 6, 2018 June 5, 2018 September 18, 2018 Topic Introduction to Disparities Strengthen Care Equity through Executive Engagement and Change Management #1 Step in Addressing Disparities: Collecting Self-Reported REAL Data Addressing Disparities in Readmission Intervening to Eliminate Disparities in Health Care Ensuring equitable care and documenting interpreter use for patients with limited English proficiency 3

Today s Objectives Review lessons learned from the field with regard to developing culturally competent interventions to eliminate disparities in healthcare. Learn about Kaiser Permanente s health equity initiatives, which earned them the inaugural CMS Health Equity Award. 4

Introducing Joseph Betancourt, MD, MPH Founder and Director, The Disparities Solutions Center Senior Scientist, Mongan Institute for Health Policy Center at Massachusetts General Hospital Director for Multicultural Education, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School Berny Gould, RN, MNA Senior Director, Quality, Hospital Oversight and Equitable Care National Health Plan and Hospital Quality Kaiser Permanente 5

Improving Quality and Achieving Equity Intervening to Eliminate Disparities in Health Care Joseph R. Betancourt, M.D., M.P.H. Director, The Disparities Solutions Center Senior Scientist, Mongan Institute for Health Policy Director for Multicultural Education, Massachusetts General Hospital Associate Professor of Medicine, Harvard Medical School 6

Outline High-Value, Transformation and Equity Making the Business Case Lessons from the Field 7

High-Value in A Time of Healthcare Transformation Value-based purchasing and health care reform will alter the way health care is delivered and financed; quality not quantity Increasing Access: Assuring appropriate utilization Linking to the PCMH, decreasing ED use & avoidable hospitalizations Improving Quality: Providing the best care Importance of Wellness, Population Management Controlling Cost: Focusing on the Pressure Points Importance of hot spotting and preventing readmissions, avoiding medical errors, and improving patient experience 8

Racial and Ethnic Disparities in Health Care A High-Value Target Racial/Ethnic disparities found across a wide range of health care settings, disease areas, and clinical services, even when various confounders (SES, insurance) controlled for. Many sources contribute to disparities no one suspect, no one solution Social Determinants of Health Navigation Communication Stereotyping Mistrust Variations in care and quality, inefficiencies, costly care and poor outcomes are the epitome of low-value 9

IOM s Unequal Treatment www.nap.edu Recommendations Increase awareness of existence of disparities Address systems of care Support race/ethnicity data collection, quality improvement, evidencebased guidelines, multidisciplinary teams, community outreach Improve workforce diversity Facilitate interpretation services Provider education Health Disparities, Cultural Competence, Clinical Decisionmaking Patient education (navigation, activation) Research Promising strategies, Barriers to eliminating disparities 10

Developing Interventions Lessons from the Field 11

Building the Foundation at MGH AHA Inaugural Equity of Care Award Winner Recognizing leaders in the field of equitable care that demonstrate success in reducing healthcare disparities and promoting diversity within their organizations. Disparities Committee Underlying Principle, 2003 While data specific to disparities at MGH important, not necessary to begin to take action given IOM Report documented issue nationally Charge Identify and address disparities in health and health care wherever they may exist at MGH Subcommittees: Quality, Patient Experience, Education/Awareness Present plan and results to Board, Executive Council and hospital leadership Build on Strong Foundation Diversity/Recruitment/Retention/Promotion at all levels, including Governance, Leadership, Physicians, Nursing, HR, GME Fortify efforts in racial/ethnic data collection, add new elements 12

AK DLP Organizations 416 participants 96 hospitals, 44 health pans 33 states and Washington D.C. Commonwealth of Puerto Rico Canada, Switzerland Provinces of Canada WA VT ME OR CA NV ID UT MT WY CO ND SD NE KS MN WI IA IL MO MI IN OH KY NY PA MD WV VA NC NH RI CT NJ DE D.C. MA Switzerland AZ NM OK AR MS TN AL GA SC TX LA FL HI DLP Participants PR

What we have learned Disparities in Quality 1. Less communication sensitive, less prevalent Beta blocker post MI, ACE with CHF 2. More communication sensitive, more prevalent Flushot, Pneumovax, Tobacco Cessation 3. Inpatient less prevalent than outpatient, especially when susceptible to social determinants (more navigation of complex systems, more challenges) Asthma, Diabetes, Colon Cancer Screening 4. Organizations that are under-resourced, and minority serving, may have overall lower quality Related to infrastructure 14

Foundation for Action We are moving to the world of big data Collect REaL will be key as we demonstrate value We are moving to the world of performance monitoring, transparency, and accountability Monitoring performance, and targeting services accordingly will be the essential foundation for care management, population health, safety, patient experience Identifying disparities can lead to high-value targets Growing interest in disparities by gender, age, sexual orientation, disability 15

Equity and Action Developing Interventions--Equity Chronic, complex, costly conditions will be managed through interprofessional, well-trained care teams focused on population health (the 20/80 rule) IT, Care coordination and training necessary Emergence of coaches, navigators, and reemergence of community health workers Utilizations, Wellness, Care Management, Transitions One size won t fit all; need focus to impact utilization, patient experience and patient safety Cross-cultural communication and Interpretation Health literacy Patient engagement and Shared decisionmaking Need to make case that will lead to better care for all patients 16

Develop Culturally Competent Interventions Diabetes Disease Management Program A quality improvement / disparities reduction program with 3 primary components: Telephone outreach to increase rate of HbA1c testing Individual coaching to address patients needs and concerns regarding diabetes self-management to improve HbA1c Group education meeting ADA requirements *Also focus on link between mental health, chronic disease management, and prevention 17

Diabetes Control Improving for All: Gap between Whites and Latinos Closing % of Patients with Poorly Controlled Diabetes (HbA1c > 8) 50% 40% 30% 20% 10% 0% 37% 34% 24% 24% 29% 20% 2007 2008 2009 Year Whites Latinos * Chelsea Diabetes Management Program began in first quarter of 2007; in 2008 received Diabetes Coalition of MA Programs of Excellence Award * 18

Navigate to Prevention and Wellness CRC Navigator Program Initiated 2005 Use of registry to identify individuals, by race/ethnicity, who haven t been screened for colon cancer Navigator contacts patient (phone or live) Determine key issues, assist in process Education Exploration of cultural perspectives Logistical issues (transportation, chaperone) GI Suite facilitates time/spaces issues 19

CRC Screening Over Time 75% Chelsea Patients Latino White CRC Screening Completion (%) 65% 55% 45% 35% 25% 2005 2006 2007 2008 2009 2010 Year 20

Educate Providers and Staff Link to Transitions, Safety, Patient Experience Quality Interactions Cross-Cultural Training as part of MGPO QI Incentive; casebased, evidence-based, interactive e-learning which allows learners to develop a skill set to provide quality to diverse populations; 150,000 trained nationwide 987 doctors completed at MGH; more than 88% said program increased awareness of issues, would improve care they provide to patients, and would recommend to colleagues; average pretest score 51%, posttest score 83% Trained 1500 frontline staff with Healthcare Professional Version Trained over 6000 health care professionals in 6 months, 16-17 1. Available at: http://www.qualityinteractions.org/prod_overview/clinical_program_features.html. 21

Patient Experience 2012 2004 Do you think the following group of patients receive a lower quality of care, same quality of care or a higher quiality of care than most White, English-speaking patients? 9.1 21.0 2012 2004 6.6 25.0 2012 2004 2.6 8.0 2012 2004 N/A 14.2 0 10 20 30 40 50 60 70 80 90 100 % Lower quality of care Hispanic/Latino (N=151) Black/African American (N=164) Asian (N=193) LEP patients (N=141) 22

Patient Perceptions of Unfair or Disrespectful Treatment Race and Ethnicity (adults 18+) 23

Preparing for the Future Addressing variations in quality such as racial/ethnic disparities in health care will be essential going forward if we are to achieve equity, high-performance and high-value This is not just about equity for equity s sake cost is key as equity connects to all areas of quality: Population Management Transitions of Care and Readmissions Appropriate Utilization and Avoidable Hospitalizations Patient Safety Patient Experience Healthcare organizations ignore this at their own peril action will separate winners from losers 24

Thank You Joseph R. Betancourt, MD, MPH jbetancourt@partners.org www.mghdisparitiessolutions.org 25

26 Berny Gould, RN, MNA Sr. Director Quality, Hospital Oversight, and Equitable Care Kaiser Permanente

Intervening to Eliminate Disparities in Health Care Berny Gould RN, MNA Sr. Director Quality, Hospital Oversight, and Equitable Care June 5, 2018

Diversity Is In Our DNA 28 June 5, 2018 HSAG HIIN Disparities Series Page 28

Kaiser Permanente The nation s largest integrated health care system. Kaiser Permanente comprises: Kaiser Foundation Health Plan Kaiser Foundation Hospitals Permanente Medical Groups Kaiser Permanente Mission Our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. 29 June 5, 2018 HSAG HIIN Disparities Series Page 29

Kaiser Permanente: By the Numbers 8 regions serving 8 states and the District of Columbia More than 12.2 million members Nearly 22,080 physicians 213,000 employees (more than 57,141 nurses) 39 medical centers (with hospitals) More than 680 medical offices (ambulatory care) $60.7 billion operating revenue (2015) 30 June 5, 2018 HSAG HIIN Disparities Series Page 30

Health Disparities Vision Statement Adopted by the Kaiser Permanente Partnership Group and endorsed by the Kaiser Foundation Health Plan/Hospitals Boards of Directors in 2007 Kaiser Permanente will: Be a leader in eliminating disparities in health and health care Provide equitable care to our members Target resources to areas of need in the communities we serve Identify and implement strategies and policies that support equity in health nationwide, including universal coverage June 5, 2018 HSAG HIIN Disparities Series Page 31

Getting Started Identified several sponsors to encourage partnerships Quality, Diversity & Inclusion, Community Benefit & Health Policy KP National Quality Committee Choose the starting points of hypertension control in African Americans and Colorectal Cancer Screening in Latinos Literature review Identified evidence Voice of the member Video ethnography was used to hear from members Expert opinion We also interviewed staff and physicians for consistency June 5, 2018 HSAG HIIN Disparities Series Page 32

Actions Service and communications tools enhanced with culturally responsive language and rationale Consistency with existing programs Allows for broad partnerships Both formal and informal champions are needed (at many levels) Re-educated on evidence based medicine and clinical practice guidelines Collaborative calls Monthly calls sharing effective practices and tools Short presentations and 30+ minutes to discuss and ask questions Annual collaborative meeting Note: Geography makes a difference Currently moving from imputed data to self reported race/ethnicity June 5, 2018 HSAG HIIN Disparities Series Page 33

Health Disparities Reasons for disparities are complex and multi-dimensional individual physical and cultural environment personal health management health care delivery and financing The challenge to health systems is to identify influential factors that are potentially modifiable through health system intervention Modifiable Measurable Clinically Significant June 5, 2018 HSAG HIIN Disparities Series Page 34

Common Modifiable Factors Patient-Provider Communication Health literacy and language proficiency are consistent predictors of disease control; over and above race/ethnicity Good communication has an impact beyond patient satisfaction Evidence that the quality of communication is associated disease outcomes (e.g., hypertension control, symptom abatement) Medication Adherence Persistence disparities in medication adherence across chronic conditions Strong evidence that improving medication adherence has the potential to reduce disparities in control (e.g., diabetes, hypertension) Copays, ease of access and regimen complexity may be important levers for intervention June 5, 2018 HSAG HIIN Disparities Series Page 35

Key Insights: The Patient Voice Know your patient. Communicate with your patient. Give the patients to have a chance to have their input. - Patient The doctor, he encouraged me, he talked to me. And that s why it is very important to be open I had someone that I could talk to. - Patient It is so wonderful for a doctor to come into that comfort zone with you and know that something s going on. Patient [The doctor] says we re a team, and she s a team with every patient she has. - Patient We know from members that there is a need for Kaiser employees and physicians to prioritize cultural competency and community partnership as central to their success. Sources: Building Trust Between African American Patients and Providers, West Los Angeles Center of Excellence for African-American Health, and Kaiser Permanente Ohio Center of Excellence for Cultural Competent Care & Health Promotion in African Americans. Kaiser Video Ethnography. June 5, 2018 HSAG HIIN Disparities Series Page 36

ECHO Conceptual Framework Aim Drivers of Equitable Care ECHO Strategies & Initiatives Equitable Care Zero Disparities ECHO: Equitable Care Health Outcomes June 5, 2018 HSAG HIIN Disparities Series Page 37

ECHO Conceptual Framework Aim Drivers of Equitable Care ECHO Strategies Initiatives Stratification of Data by Race/Ethnicity Diversity and Inclusion Culturally Responsive Care Collection and Leverage of Data Collection of Data with Every Phase of Strategy Implementation Identification of Effective Practices from Data Use of Data to Spread Equitable Care = Zero Disparities Partnership Collaboration Trust Building Health Promotion Utilization of Communication Tools Culturally Responsive Care Patient Healthy Lifestyle Support Patient Education and Self- Efficacy Community Education and Outreach Identification and Spread of Effective Practices Evidence-Based Medicine Clinical Guideline Practices Research Putting Innovative Ideas Into Action Spread of Effective Practices Use of Innovative Toolkits June 5, 2018 HSAG HIIN Disparities Series Page 38

Page 39 Methodology for Achieving Goal Utilization of Performance Improvement Processes Assessment and Baseline Measurement Process Evaluation and Change Implementation and Testing Outcome Evaluation Spreading Evidence Based Medicine Collection and Use of Data Trust Building Collectio n and Use of Data Health Promotion Putting Innovative Ideas into Action Evidence- Based Medicine Collection and Use of Data Trust Building Collection and Use of Data

Improving Hypertension Control Among African Americans Challenge Clinical Management Goals Leverage Points (potential indicators) Targets for Disparities Reduction Cultural Competency Proposed Disparities Reduction Strategies (examples) Clinic-Level Education/Feedback Improve Hypertension Control among African Americans Appropriate Medication/ Appropriate Dose (National HTN algorithm) Follow Up & Monitoring Medication Adherence Lifestyle Modification KP National Hypertension Guideline: Link Hypertension/ Disparities Literature Failure to Intensify Therapy* Patient- Clinician Relationship (duration/ frequency of relationship, patient satisfaction)* Health Care Access (nonattendance at scheduled visits, nonadherence to medicines/ labs)* Patient Knowledge Patient Diet/Exercise Patient Supports/ Resources Decision Support Services Trust Building & Continuity of Care Accessibility of Information (language, literacy, context) Patient Cost Burden Ease of Access to Care Patient Education & Self-efficacy Patient Lifestyle Support (stress reduction) Community Education & Outreach Centralized Population Care Health Connect Reminders (consolidate Rx/combo Rx/dose) Provider-Level Education/ Feedback New Patient Outreach calls Culturally & Linguistically Appropriate Education & Case Management Barriers Assessment (motivational interviewing) Tech Based Self-Management Support (cell phones, internet) Referrals for Health System Specialty Services/Classes Family-Based Interventions (cooking classes, salt education) Partner with Community Providers and Organizations (barber shops, churches) *Available from existing KP data sources June 5, 2018 HSAG HIIN Disparities Series Page 40

Align Across the Organization: Collaboration Community Benefit Executive D&I Council Community Health Needs Assessment Human Resources Quality & Service Care Delivery Members The Permanente Federation (CMI) National & Regional Councils Regional Operations National Supplier Diversity Regional Diversity Physicians Compliance June 5, 2018 HSAG HIIN Disparities Series Page 41

Race and Ethnicity of Membership Kaiser Permanente Statistics do not include Washington Region members June 5, 2018 HSAG HIIN Disparities Series Page 42

Is something impacting your results? Collection of Race and Ethnicity Data Percent of Total Membership* with Race/Ethnicity Data Entered in Kaiser Permanente HealthConnect Combined Race Format Categories Black or African American Hispanic or Latino Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native White Ethnicity 268 granular ethnicities *Statistics do not include Washington Region members June 5, 2018 HSAG HIIN Disparities Series Page 43

Primary Spoken Language and Need for an Interpreter 57% of members whose primary spoken language is Spanish need an interpreter 3 rd Quarter 2017 *Statistics do not include Washington Region members June 5, 2018 HSAG HIIN Disparities Series Page 44

What does it take to reach goal or How big is the problem? June 5, 2018 HSAG HIIN Disparities Series Page 45

What is the Hypertension Story Controlling High Blood Pressure for Kaiser Permanente Members in the HEDIS denominator, stratified by a combination of reported and imputed race/ethnicity 90% 85% 80% 75% All Members Asian or Pacific Islander White Black or African American Hispanic or Latino HEDIS National 90th Percentile 9% 8% 7% 6% 5% 4% 3% 2% 1% White Rate minus Black/African American Rate 70% 09Q4 10Q1 10Q2 10Q3 10Q4 11Q1 11Q2 11Q3 11Q4 12Q1 12Q2 12Q3 12Q4 13Q1 13Q2 13Q3 13Q4 14Q1 14Q2 14Q3 14Q4 15Q1 15Q2 15Q3 15Q4 16Q1 16Q2 16Q3 16Q4 17Q1 17Q2 17Q3 0% June 5, 2018 HSAG HIIN Disparities Series Page 46

HEDIS Controlling High Blood Pressure: Medicare Members Kaiser Permanente Programwide Statistics do not include KP Washington members June 5, 2018 HSAG HIIN Disparities Series Page 47

Drill down data: Age and Race/Ethnicity June 5, 2018 HSAG HIIN Disparities Series Page 48

Drill down data: Age, Gender, Language & Product Line June 5, 2018 HSAG HIIN Disparities Series Page 49

Targeted Interventions Dietary salt questionnaire to direct sodium intake behavior, because blacks are more salt sensitive Optimizing thiazide dosing to HCTZ 50mg or chlorthalidone 25mg Spironolactone 12.5 to 25mg to substitute for potassium replacement Panel management with flexible Advanced Practice Provider support and primary care ownership June 5, 2018 HSAG HIIN Disparities Series Page 50

Dietary Salt Questionnaire Dietary salt questionnaire to direct sodium intake behavior How many times a week do you eat out? How many days a week do you eat processed foods or meats (this includes canned, packaged, or frozen foods, and salt pork, sausage or lunch meats)? Do you add salt when you cook? Do you add salt to your food? June 5, 2018 HSAG HIIN Disparities Series Page 51

Motivational Interviewing June 5, 2018 HSAG HIIN Disparities Series Page 52

5 3 EQUITABLE CARE HEALTH OUTCOMES (ECHO) Quick Tips: Motivational Interviewing Quick Tip 1 Quick Tip 2 Quick Tip 3 Quick Tip 4 Quick Tip 5 Quick Tip 6 Sharing Clinical Results with Your Patient: I have the results of your tests, let s talk about them. Negotiating the Agenda with Your Patient: What is the most important thing for us to talk about today? Assess Readiness with Your Patient: Tell me what else you think you can do to control your diabetes? Asking Permission: May I talk to you about X today? Exploring Ambivalence: What do you think is holding you back from improving your diabetes care? Offering Advice: The most important thing you can do to help your diabetes today is to start/continue X June 5, 2018 HSAG HIIN Disparities Series Page 53

EQUITABLE CARE HEALTH OUTCOMES (ECHO) The AIDET Service Model for Blacks Acknowledge DO: Address the patient by their title and surname. DO: Touch, Shake hands, warmly greet. Create familiarity by asking general questions the member is comfortable talking about. DO: Include family members the patient designates to be involved with their treatment Introduce DO: Introduce yourself with your full name and your experience and qualifications to treat the medical condition of the patient. DO: Introduce or talk about your team. Duration DO: Avoid being rushed, address multiple stressors such as work, relationships, financial concerns which may impact adherence DO: Explain all diagnoses, tasks, processes and procedures, time for reports, time to recovery DO: Provide positive reinforcement to progress Explanation DO: Explain side effects of medications in such a way that the patient does not perceive he/she is being experimented on ASK: What are you going to do at home to take care of your diabetes? Thank You ASK: Did you get what you needed? DO: End with a handshake, farewell, and personal conversation. June 5, 2018 HSAG HIIN Disparities Series Page 54

EQUITABLE CARE HEALTH OUTCOMES (ECHO) The 4 Habits Service Model for Blacks Invest in the Beginning DO: Address the patient by their title and surname, NOT their first name ASK: (record and get ROI) which family member the patient would like to include in their treatment, communicate with the designee with the patient s permission, to improve adherence, communication DO: Introduce: First and last name, background, skills, your experience, the experience of the team DO: Touch, shake hands, warmly greet, sit comfortably close DO: Avoid being rushed Elicit the Patient Perspective DO: Elicit the patient questions, ask them to make a list of questions for the next visit or call you ASK: What treatments do you use at home or with others to make yourself feel better? ASK: What beliefs do you have that may impact your health? ASK: What are you doing at home to take care of your diabetes? DO: Explain the side effects of medications and treatments in a way that the patient does not feel he/she is being experimented on Demonstrate Empathy DO: Look for opportunity to make empathetic response about the patients concern DO: Use a pause, touch, or concerned facial expression DO: Compliment the patient on efforts to address the problem and emphasize positive steps Invest in the End DO: Explain all tasks, processes and procedures ASK: Can you get your medicine, food, transportation to the clinic? ASK: What are you going to do to take care of your diabetes when you leave (goal setting and action planning)? ASK: Did you get what you needed? DO: End with a handshake, farewell, and personal conversation June 5, 2018 HSAG HIIN Disparities Series Page 55

EQUITABLE CARE HEALTH OUTCOMES (ECHO) The AIDET Service Model for Blacks Acknowledge Introduce DO: Address the patient by their title and surname. DO: Touch, Shake hands, warmly greet. Create familiarity by asking general questions the member is comfortable talking about. DO: Include family members the patient designates to be involved with their treatment DO: Introduce yourself with your full name and your experience and qualifications to treat the medical condition of the patient. DO: Introduce or talk about your team. Duration Explanation DO: Avoid being rushed, address multiple stressors such as work, relationships, financial concerns which may impact adherence DO: Explain all diagnoses, tasks, processes and procedures, time for reports, time to recovery DO: Provide positive reinforcement to progress DO: Explain side effects of medications in such a way that the patient does not perceive he/she is being experimented on ASK: What are you going to do at home to take care of your diabetes? Thank You ASK: Did you get what you needed? DO: End with a handshake, farewell, and personal conversation. June 5, 2018 HSAG HIIN Disparities Series Page 56

Future Direction HbA1c < 8.0%: Average of Gaps for the Four Largest Racial/Ethnic Groups 'Gap' is the difference between RE Group's HbA1c < 8.0% Rate and HEDIS National 90th Pctile Kaiser Permanente Programwide 12% 10% 8% 6% 4% 2% 0% -2% 14Q2 14Q3 14Q4 15Q1 15Q2 15Q3 15Q4 16Q1 16Q2 16Q3 16Q4 17Q1 17Q2 17Q3 Average of Gaps 5.0% 4.1% 3.7% 6.9% 5.8% 3.7% 2.2% 4.2% 3.7% 3.0% 2.1% 3.9% 3.1% 2.4% White 1.3% 0.0% 0.0% 3.1% 2.1% 0.0% 0.0% 0.7% 0.0% 0.0% 0.0% 1.0% 0.0% 0.0% Black or African American 7.4% 6.6% 6.1% 9.1% 7.9% 5.9% 2.8% 5.9% 5.5% 3.4% 1.6% 4.6% 4.0% 2.5% Asian or Pacific Islander 1.4% 0.1% 0.0% 3.5% 2.3% 0.0% 0.0% 0.7% 0.0% 0.0% 0.0% 0.5% 0.0% 0.0% Hispanic or Latino 10.0% 9.7% 8.8% 11.8% 10.8% 9.0% 6.0% 9.7% 9.3% 8.5% 6.8% 9.5% 8.4% 6.9% June 5, 2018 HSAG HIIN Disparities Series Page 57

An Evolving Vision We are stretching the boundaries around how care is delivered by integrating with the member s life. HOME WORK Bernard J. Tyson Chairman and CEO Kaiser Permanente SCHOOL HOSPITAL CLINIC COMMUNITY CONNECTED CARE 58 June 5, 2018 HSAG HIIN Disparities Series Page 58

Audience Q&A Questions? 59

Disparities Webinar Series Date September 19, 2017 November 28, 2017 January 30, 2018 March 6, 2018 Topic Introduction to Disparities Strengthen Care Equity through Executive Engagement and Change Management #1 Step in Addressing Disparities: Collecting Self-Reported REAL Data Addressing Disparities in Readmission June 5, 2018 September 18, 2018 Intervening to Eliminate Disparities in Health Care Ensuring Equitable Care and Documenting Interpreter Use for Patients with Limited English Proficiency (LEP) 60

Thank you! Boris Kalanj, MSW Director, Cultural Care and Experience PFE and Disparities Leader, Health Services Advisory Group (HSAG) HIIN bkalanj@hqinstitute.org 61

For continuing education credit (1), please complete the evaluation at: https://goo.gl/aoxwrc If you registered online for this event, you will also receive the link via email. A recording of today s session will be available at: www.hsag.com/hiin/events (Click on today s event date to access the recording link) 62