On The Road To Eliminating Health Disparities

1. On The Road To Eliminating Health Disparities Community Health Partnership Washington, D.C May 20, 2008 Malcolm Joseph, III, MD, MPH Medical Director CareFirst BlueCross BlueShield is an independent licensee of the Blue Cross and Blue Shield Association. ® Registered trademark of the Blue Cross and Blue Shield Association. ®’ Registered trademark of CareFirst of Maryland, Inc.

2. About CareFirst • Location of Region(s) Maryland, District of Columbia, Northern Virginia, and Delaware • Products offered • Point of Service plans (POS); Preferred Provider Organizations (PPO); Managed Care Organization (HMO) • Consumer Directed Health Plans • Membership • 3.3 Million members • Market Share • 39% in service area

3. Mission Statement To provide health benefits of value to customers across the region comprised of Maryland, Delaware and the National Capital area. To fulfill this mission, CareFirst commits: • To offer a broad array of quality, innovative insurance plans and administrative services that are affordable and accessible to our customers

4. Mission Statement • To fairly address the needs of customers in each of the jurisdictions in which we operate. • To conduct business responsibly as a non-profit health services plan, to ensure the Plan’s long-term financial viability and growth. • To support public and private efforts to meet needs of persons lacking health insurance.

5. Mission Statement • To collaborate with the community to advance health care effectiveness and quality • To foster health systems integration and health care cost containment to benefit the people in areas we serve • To promote respect, fairness and opportunity for our associates

6. Increasing Diversity • Minority Population and other language spoken is 38%

8. The IOM Report • The IOM report1 called “Unequal Treatment: Confronting Racial and Ethnic disparities in Healthcare”, found and documented extensively that racial and ethnic disparities exist regardless of socioeconomic factors such as health insurance coverage and income. • Other reports: National Healthcare Disparities Report2 provided data for measuring the effectiveness of national initiatives to reduce disparities.

9. IOM Recommendations • CareFirst has adapted the IOM recommendation to “promote the consistency and equity of care through the use of evidence-based guidelines”.

10. Quality Care • The IOM Report defines quality care for the 21st Century. • CareFirst acceptance of IOM’s definition of quality care requires that care be safe, timely, effective, efficient, equitable and patient-centered. • These parameters of quality care are particularly applicable to minority populations who have poorer quality of health and worst outcomes

11. Quality & Safety The case for addressing quality and patient safety Effects of poor quality care • 44,000-98,000 deaths/year from medical errors - more than breast cancer, AIDS, or motor vehicle accidents (IOM, To Err Is Human, 1999) • Only 55% of patients receive recommended care (McGlynn, New England Journal of Medicine, 2003) • Poor quality costs $17-$29B/year Why isn’t quality better? • Health care complex, poorly organized • Inadequate information infrastructure • “Toxic” payment system – rewards unrelated to quality Attributes of quality care(Institute of Medicine, Crossing the Quality Chasm, 2001) Safe - avoid harm or injuries from care intended to help Timely - no unnecessary waits Effective - evidence based treatments and technology Efficient - not wasteful Equitable - same for all regardless of gender, race, ethnicity, age Patient-Centered - responsive to preferences, needs and values

13. Ensuring Affordability • Raising the Bar • Bridges to Excellence (BTE) • Patient Safety Centers (PSC) • Intensive Care Initiatives (ICU) • Health Information Technology Initiatives (HIT) • Closing the Gaps • Cardiovascular disease in African Americans • Diabetes in Hispanics • Cervical cancer in Asian women

14. Cultural Diversity Training Do you know me?

15. Barriers and Challenges Contributors to health disparities • High rates of poverty • Unemployment • Uninsured • Access to care • Low primary and specialty care rates • Critical shortages of physician and medical providers • Lack of EMR • Coordination/fragmentation of Care

16. Removing Barriers • Adapt IOM recommendations to reduce health disparities • Develop collaborative partnerships • Private and public sector, general public and • key stakeholders work together • Increase awareness of disparities • Increase health care provider awareness • Race and ethnicity data collection

17. CareEssentials 17 Prevention“Keeping the healthy, healthy.” My Care First Options Health Education MyHealthProfile Lifestyle Management Healthy Lifestyle Coaching Workplace Solutions Utilization Management“Right care. Right time. Right place.” Hospital Pre-Auth Discharge planning, concurrent review Networks Mgmt. Pharmacy Mgmt. Disease Management“Smart choices for healthy living.” Asthma Diabetes CHF/CAD COPD * Other Options Available Case Management“When care is needed most.” Assist member in navigating complex health condition/ experience Great Beginnings

18. The Case for Closing the Gaps • CareFirst Mission • Increasing Diversity in CareFirst Region • National Concerns - IOM Report • Health Issues and Disparities

19. Closing the Gaps How CareFirst can be a part of thesolution CareFirst has partnered with La Clinica del Pueblo (a D.C. based clinic) in a three year project to improve the care for diabetes in the Latino population. Program launched - April 2005 Diabetes in the Latino Population CareFirst has partnered with Boat People S.O.S. to increase awareness and improve screening rates for cervical cancer among Vietnamese women. Program launched - September 2005 Cervical Cancer in Vietnamese women CareFirst has partnered with University of Maryland School of Medicine to provide blood pressure screening and cardiovascular risk factor awareness to African Americans through a community-based program in barber shops and hair salons in Baltimore Program launched - September 2005 Cardiovascular Disease in African Americans CareFirst partnered with Manhattan Cross Cultural Group to provide cultural competency training to internal staff clinicians. Program launched - Dec. 2005 Clinician cultural Training