A recent federal report on COVID-19 infections and deaths by race showed that Black and Latinx populations in the United States are three times more likely to contract COVID-19 and nearly twice as likely to die from it. For organizations such as MN Community Measurement, who has been reporting on health disparities since 2009, the disproportionate impact of COVID-19 on minority groups was not news.
MN Community Measurement (MNCM) is a Regional Health Improvement Collaborative (RHIC) and Network for Regional Healthcare Improvement (NRHI) member dedicated to empowering healthcare decision makers with meaningful data to drive improvement. MNCM works with doctors, hospitals, clinics, insurance companies, and state agencies to collect, analyze, and report healthcare data related to quality, cost, and patient experience. MNCM is one of the many RHICs across the U. S. that reports on state and regional health disparities, and through partnerships with health systems, health plans, and local governments, is sharing this data with hopes to make a difference in decreasing disparities.
NRHI, a national convener of health collaboratives, recently held a webinar with guest speakers MN Community Measurement, (link goes to ), and Wisconsin Collaborative for Healthcare Quality (WCHQ), a RHIC and NRHI member, where they discussed the opportunities in decreasing regional health disparities when RHICs form partnerships with health plans, health systems, local governments, and other entities working closely with community organizations.
Creating Trusted Race, Ethnicity, Language (REL), and Country of Origin Data
In 2008, MN Community Measurement sought partnerships with health plans and health systems to develop a handbook of best practices on collecting data on race, ethnicity, language (REL), and country of origin. To this day, the handbook continues to be a reliable source of best practices for collecting and reporting data. A key principle in establishing the standards for these best practices was the data had to be self-reported by patients.
After six years of improving the quality of the data through implementing strict standards, ongoing data audits, and building trust in its reliability, MNCM began publishing and broadly disseminating their health disparities reports. The comprehensive, statewide data reporting offers a unique model for highlighting both the “bright spots” and need for improvement.
Similarly, in 2018, with funding from the University of Wisconsin Health Innovation Program, WCHQ conducted a statewide health disparities report using WCHQ quality measures. The report, published in 2019, focused on race/ethnicity, payer type, and rural/urban settings. While this was not their first data report, it was the first that aimed to gain broader publicity and reach alerting the public’s attention to significant regional health disparities. To ensure accuracy, WCHQ conducted cross-verification by utilizing sources such as the U.S. Census. An important way to preserve the integrity of the data, and the role of the RHIC, according to Matt Gigot, Director of Performance Measurement & Analysis, was to focus on reporting the results and avoiding specific recommendations that could be interpreted as advocacy work.
Remaining Neutral to Preserve Data Integrity Is a Challenge for RHICs
Regional Health Improvement Collaboratives are neutral conveners governed by four key stakeholders – providers, payers, purchasers, and consumers – to create opportunity for diverse perspectives to be considered when creating solutions to complex problems. For both MNCM and WCHQ drawing a line between the politics and the advocacy and their own reporting is the way to maintain the objectivity and trust in their data. In many aspects it is critical for RHICs to understand their role and the expertise they bring. For example, RHICs do not always have the tools to act upon the data provided in the health disparities reports. “We do not provide healthcare, we don’t pay for healthcare,” points Julie Sonier, President and CEO of MN Community Measurement.
While it is true that MNCM could not directly act upon the data provided in the reports, they serve as “behind the scenes” advocates. Making the data transparent and publicly available calls the public’s attention to the problem, motivates efforts to improve, and enables progress tracking. With the goal of remaining neutral in their reporting, “shining a light on these disparities is [already] a form of advocacy,” says Sonier.
Public-Private Partnerships Can Make a Difference in Decreasing Health Disparities
The wide-spread dissemination of the health disparities reports offers opportunities for RHICs to build strong relationships with organizations that can take the data and move it forward. Sonier clarifies, “It is through the partnerships with health systems, health plans, and community organizations positioned to take this information and use it to motivate, inform, and evaluate improvement initiatives that MNCM tackles the health disparities uncovered in the reports.” In a comment about MNCM’s most recent report, Blue Cross and Blue Shield of Minnesota Vice President and Chief Medical Officer Dr. Mark Steffen MD, MPH, points out that “the comprehensive tracking and analysis that this report brings us will give detailed insights that can empower health care decision makers with meaningful data to create an equitable Minnesota.”
Matt Gigot of WCHQ echoes Sonier’s perspective. When the 2019 WCHQ health disparities report was finalized, they disseminated it to a wide range of stakeholders – not only health systems and health plans, but also the local media and the state government. They also held an in-person statewide launch, where they presented the results in a variety of forums. WCHQ’s partnership with the University of Wisconsin Health Innovation Program and their current work includes developing reports not at system level but at zip code level to set up quality measure performance based on geographic region.
Using Data to Improve Equity: Example Colorectal Cancer Screening Data from MNCM
During the webinar, Sonier used colorectal cancer screening as an example of how partnerships can bring a real change when hospitals and health plans act upon the data RHICs provide.
Colorectal cancer is the second most common cause of death from cancer in the U.S. Early detection and treatment are associated with higher survival rates and lower treatment cost. However, MNCM’s report on colorectal cancer screening by race and ethnicity showed that while almost 73% of patients who identify as White get regularly screened, these numbers are 54% for American Indian, 58% for Blacks, and 59% for Native Hawaiians and other Pacific Islanders living in Minnesota.
Blue Cross and Blue Shield of Minnesota has a value-based purchasing program that includes financial incentives to reduce disparities in colon cancer screening. Between 2013 and 2017, providers participating in this program increased colon cancer screening rates for non-White patients by 3 percentage points; meanwhile, there was no change in the disparity for other providers.
Similarly, CentraCare focused on outreach to patients at its clinic location with the largest number of patients of color. In less than a year, they improved the percentage of patients of color at this clinic who were up to date on colon cancer screening from 35% to 46%. The intervention at this single clinic improved the systemwide rate for all patients of color from 50% to 56%.
Finally, HealthPartners used a variety of strategies, including EHR decision support, shared decision making (FIT/colonoscopy), addressing clinician unconscious bias, and patient outreach to reduce racial disparities in colon cancer screening. Rates improved substantially for all patients over time, and the size of the gap between patients who are White, and patients of color fell by 14 percentage points.
Both Julie Sonier and Matt Gigot agreed that there is more work to be done to take the reports from data to action. Finding partners who not only can act upon that data – such as health systems, health plans, and state and local governments – but also amplify the importance of health disparities reporting from the community to the national level, is one of the ways that RHICs reporting can make a difference in decreasing health disparities. The Network for Regional Healthcare Improvement, as a national membership organization, offers a broader platform and continuous dissemination of its members’ work, in this case, reporting on health disparities. NRHI’s commitment to make a health equity a daily habit can mean finding the right channels to share the work of its members and the issues they are working to solve as multi-stakeholder health improvement organizations.