Office of Health Equity

1. Office of Health Equity JudyAnn Bigby, M.D. Secretary Executive Office of Health and Human Services

2. Presentation Overview • Health Disparities Council Framework • Diabetes as a Disease State Case Study • Application of Framework EOHHS Office of Health Equity

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6. Quality Improvement in Diabetes Care LDL Testing LDL <130 Statin Use EOHHS Office of Health Equity Seaquist TD et.al Arch Intern Med 2006;166:675-81

7. Framework for Addressing Health Disparities Access to Health Care Societal/policy Factors 5 Individual Factors 2 Extent and Quality of Health Care 1 Institutional transformation 3 Community Factors 4 Personal Health Behaviors EOHHS Office of Health Equity

8. Diabetes as a Disparities Disease State Case Study EOHHS Office of Health Equity

9. Expected Outcomes • Improve quality of diabetes care for racial and ethnic minority groups • Decrease diabetes related morbidity and mortality • Decrease disparities in prevalence of diabetes through prevention and early detection • Break the cycle of increasing obesity among blacks and Latinos by making communities healthier EOHHS Office of Health Equity

10. Current Initiatives • Patient Centered Medical Homes Initiative • Masshealth Pay-for-Performance • Race and Ethnicity Data Collection Efforts • DPH Community Grant Program • HealthyMass Diabetes Task Force EOHHS Office of Health Equity

11. Framework for Addressing Health Disparities Access to Health Care Societal/policy Factors 5 Individual Factors 2 Extent and Quality of Health Care 1 Institutional transformation 3 Community Factors 4 Personal Health Behaviors EOHHS Office of Health Equity

12. Improving Access to and Quality of Care (1) • Patient Centered Medical Homes Initiative • Diabetes as clinical focus • MassHealth dominant practices • Improve disease management for populations served • MassHealth Pay-for-Performance • Performance payments made to hospitals and providers based on presences of infrastructure to track and address disparities • Report disparities; address disparities • Race and Ethnicity Data Collection Efforts • Stratification of Data by Race and Ethnicity EOHHS Office of Health Equity

13. Diabetes Task Force: Goals • Integration of public health and medical care • Early detection and chronic disease management using chronic care model • Decrease hospitalizations and readmissions • Decrease complications EOHHS Office of Health Equity

14. Diabetes Task Force • Help providers adhere to the Massachusetts Guidelines for Adult Diabetes Care for patients with diabetes and pre-diabetes. • Implement systems changes that will facilitate a coordinated, multidisciplinary team approach to care. • Increase the number of patients with diabetes who receive diabetes self-management education (DSME) and medical nutrition therapy (MNT) in accordance with state guidelines. • Ensure that appropriate staffing levels, training programs and certification resources exist to provide the full range of services needed for patients with diabetes and pre-diabetes. EOHHS Office of Health Equity

15. Individual Factors: Personal Behaviors (2) • Mass in Motion • Promote healthy behaviors related to eating and physical activity • Focus on culturally appropriate materials • Community based initiatives • Diabetes Task Force • Develop TV, radio and print campaign with diabetes-specific message to reach a broad audience - Diabetes can affect anyone. The task Force recommends a focus on the “Many Faces of Diabetes.” • Create a healthy workplace environment for preventing and managing diabetes resulting in measurable and improved outcomes for adults living with diabetes. • Develop a high-level statewide public awareness and education campaign targeting high risk groups • Increase the number of patients with diabetes who receive diabetes self-management education (DSME) and medical nutrition therapy (MNT) in accordance with state guidelines. EOHHS Office of Health Equity

16. Institutional Transformation (3) • Partner with Health Plans to identify best practices • Massachusetts Guidelines for Adult Diabetes Care implementation and best practices to outcome and performance measurement (1,2, 3 and 5) • MassHealth P4P • Performance measures reward reporting and decreasing disparities • HCQCC • Performance measurement alignment • Inform work to align measurements related to disparities EOHHS Office of Health Equity

17. Community Factors (4) • Diabetes Task Force • Expand the Working on Wellness Initiative to additional employers across the state. • Develop TV, radio and print campaign with diabetes-specific message to reach a very broad audience - Diabetes can affect anyone. The task Force recommends a focus on the “Many Faces of Diabetes.” • Improving access to affordable healthy foods in communities • Promoting physical activity • Transportation compact • DPH wellness grants to communities EOHHS Office of Health Equity

18. Sociopolitical/Policy Factors (5) • Transportation Bill • Requires community health impact assessment • Promotes policies to promote physical activity as transportation initiatives are developed in all communities. EOHHS Office of Health Equity

19. Discussion • Gaps • Recommendations from Council • Framework applied to other disease states • Infant mortality • Asthma • Other EOHHS Office of Health Equity