Overview

1. Disparities in Health Care: Issues for National ReportingKalahn Taylor-Clark, PhD, MPHResearch Director, Racial/Ethnic Health Care Equity InitiativeThe Brookings InstitutionAHRQ 2009 Annual Conference

2. Overview • Integrating equity in the data environment • Overview of key IOM recommendations • High Value Health Care Project/Equity Initiative • Considerations for implementation of recommendations

3. Integrated Delivery Systems HealthPlans Registries HIEs Advancing Health Care Equity: Integrating the Data Environment Data on care experience, health status, race/ethnicity, language (Stratified) Performance information for informed selection of providers Data Exchange/Transfer Incentives for improvement; Benchmarks Public and Private Payers Public Reporting Organizations

4. Institute of Medicine (IOM) ReportKey RecommendationsSubcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality ImprovementAugust 31, 2009 • Entities should collect data on granular ethnicity and elicit race responses consistent with current OMB standards • Collect data on preferred language and level of English proficiency • Develop standards to support data exchange of race/ethnicity/language across multiple entities • Utilize indirect estimation where self-reported data are unavailable

5. Racial/ethnic Health Care Equity InitiativeMotivation and Goals Goals of Racial/ethnic Health Care Equity Initiative Promulgate best practices for collecting, monitoring, and disclosure of race/ethnicity data to promote equity in care across all groups. Motivation Findings • Consistent body of research demonstrates significant variation in the rates of medical procedures by race, even when insurance status, income, age, and severity of conditions are comparable. Recommendations • Health care organizations should collect, report, and monitor patient-care data to build a foundation for solutions to racial/ethnic disparities in care • Increase equity in care by increasing accountability and monitoring and improving clinical care quality Challenges • Despite continued attention to data concerns, inadequate information continues to limit the analyses of health care-related disparities and their outcomes.

6. Massachusetts Quality and Cost CouncilUniform Reporting System for Health Care Claims Data Sets 129 CMR 2.00 Ethnicity Code Code Description 2182-4 Cuban 2184-0 Dominican 2148-5 Mexican, Mexican American, Chicano 2180-8 Puerto Rican 2161-8 Salvadoran 2155-0 Central American (not otherwise specified) 2165-9 South American (not otherwise specified) 2060-2 African 2058-6 African American AMERCN American 2028-9 Asian 2029-7 Asian Indian BRAZIL Brazilian 2033-9 Cambodian CVERDN Cape Verdean CARIBI Caribbean Island2034-7 Chinese 2169-1 Columbian 2108-9 European 2036-2 Filipino 2157-6 Guatemalan 2071-9 Haitian 2158-4 Honduran 2039-6 Japanese 2040-4 Korean 2041-2 Laotian 2118-8 Middle Eastern PORTUG Portuguese RUSSIA Russian EASTEU Eastern European 2047-9 Vietnamese OTHER Other Ethnicity UNKNOW Unknown/not specified Race Code Code Description R1 American Indian/Alaska Native R2 Asian R3 Black/African American R4 Native Hawaiian or other Pacific Islander R5 White R9 Other Race UNKNOW Unknown/not specified

7. Suggested Categories for Collecting RACE/LATINO ETHNICITY IDENTIFIER(QCC) * Check All That Apply • American Indian/Alaska Native • Asian • Black • Hispanic/Latino/White • Hispanic/Latino/Black • Hispanic/Latino/Other • Native Hawaiian/Pacific Islander • White • Declined * If organization does not have space to collect more than one race/Latino ethnicity category, health plan may submit a waiver to include “multiracial” as a category.

8. LANGUAGE REPORTING *U.S. Census Report:http://www.fairus.org/site/PageNavigator/facts/state_data_MA **FLNE - a bi-annual publication of MDPH with language data collected by the Massachusetts Department of Education for students whose primary language is not English.

9. Integrated Delivery Systems HealthPlans Registries HIEs Advancing Health Care Equity: Integrating the Data Environment Data on care experience, health status, race/ethnicity, language (Stratified) Performance information for informed selection of providers Data Exchange/Transfer Incentives for improvement; Benchmarks Public and Private Payers Public Reporting Organizations

10. Considerations for Developing Guidelines Consumer preferences. What are consumers’ concerns about direct data collection by plans? What are consumer preferences for reporting race/ethnicity (e.g. available response categories)? To what messages about data collection activities/benefits do various consumer populations respond? What information on health care equity do consumers want to know? Modes of data collection. What are organizations’ capabilities for acquiring directly collected or third party source data? What are cost effective modes of data collection for organizations? Use of data. How will organizations and State analyze data? What will (goals of) interventions be (i.e. quality advancement v. disparities reduction)? Who will be involved?

11. Considerations for Developing Requirements • Developing standard categories and thresholds for reporting • Acquiring third party source data  Submission protocols/file formats • Incorporating indirectly estimated data  Submission protocols/File formats  Incorporating directly collected and indirectly estimated data

12. Thank You!! ktclark@brookings.edu