It’s Time for a New Message: Moving the Discussion from Diversity and Disparities to High-Performance and High-Value Panelists: Peter Slavin, MD, President, Massachusetts General Hospital Deborah Enos, MSPH, President & CEO, Neighborhood Health Plan
Moderator: Joseph Betancourt, MD, MPH, Director, the Disparities Solutions Center Words carry great meaning, and they can also engender unanticipated responses among any individual or audience we are trying to engage around change. While increasing diversity in the health professions and addressing disparities in health care are the common threads that bring us all together, might these terms marginalize this work? This provocative presentation will highlight the importance of increasing diversity and addressing disparities, yet share a cogent argument for how we need to rebrand and retrofit this work within the context of high-performance and high-value healthcare. Making the case that these are one in the same, this presentation will provide some key perspectives on how we need to evolve our discourse from the “need to do”, social justice angle, to the “must do” angle, from the quality, value, and business standpoint.
Grounding Session I Population Health: One Size Won’t fit All Panelists:
Shikha Anand, MD, MPH,Director of Strategic Alliances and Initiatives and Obesity Program Director, National Institute for Children’s Health Quality J. Emilio Carrillo, MD, MPH, Vice President, Community Health, NewYork-Presbyterian Hospital, Associate Professor, Clinical Public Health and Medicine, Weill Cornell Medical School Winston Wong, MD, MS, Medical Director, Community Benefit, Kaiser Permanente
Moderator: Alexander Green, MD, MPH, Associate Director, the Disparities Solutions Center
As we move towards greater accountability in health care, the transition from disease management to population health management will be key part of the puzzle. Instead of delivering care patient by patient, we will instead need to consider the impact of chronic conditions on populations, while preparing to meet all the health care needs of diverse populations. To be successful we must have access to good data, solid strategies that bridge public health to health care, and a set of tactics that allow us to focus on patient vulnerabilities. We must also build in the capacity to manage a broad array of social and cultural factors that include life control, cultural beliefs, limited-English proficiency and low health literacy, among others. How will we achieve this? How will we realize the promise of population health for all, not just a select few? Will one size fit all? This presentation will provide answers to these and other questions from leaders who bring different vantage points to the discussion, including the health plan, hospital, and children’s health perspective.
Workshop A* Children Matter Too: Perspectives from the DLP Pediatric Health Equity Collaborative Panelists: Arie Nettles, PhD, NCSP, HSP, Associate Professor of Clinical Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt Kirk Dabney, MD, MHCDS, Clinical Director, Office of Health Equity and Inclusion, Nemours/Alfred I DuPont Hospital for Children John Cowden, MD, MPH, Medical Director of Equity and Diversity, Children’s Mercy Hospitals and Clinics
Moderator: Aswita Tan-McGrory, MBA, MSPH, Deputy Director, the Disparities Solutions Center
Many of the essential components of healthcare transformation seem to focus on adult populations. From initiatives to reduce readmission rates for conditions such as congestive heart failure, to strategies that aim to improve patient experience, the needs of children and their families don’t seem to be receiving equal attention. This is even more pronounced when it relates to disparities, quality, and equity of care for children. Ultimately, if health care transformation is successful and value to be achieved, equity of care should be thought of across the lifespan, and it needs to begin with children’s health. This workshop, led by a collaborative of leaders from children’s hospitals across the country who have participated in the Disparities Leadership Program, will provide insights on what they are doing to improve quality and achieve equity, and where they see the field moving.
Support for this panel is provided by the Office of Minority Health at Centers for Medicare and Medicaid Services.
Workshop B* More than just Meds: Addressing Social Determinants and Improving Access to Care Panelists: James Corbett, JD, MDiv, Senior Vice President, Community Health and Values Integration, Centura Health Brian Hermanspan, Vice President of Business Development, Health Leads
Moderator: Alden Landry, MD, MPH, Senior Faculty, the Disparities Solutions Center As we focus on the triple aim, improving meaningful access to care, and addressing social determinants as part of population health, will be critical to achieving success. No longer can we just focus on prescribing meds and other more traditional approaches to care and wellbeing. Being creative to assure patients have insurance when eligible, and know how to use it appropriately—as well as effectively managing the social determinants of health that complicate the management of chronic diseases—will be essential to drive value, eliminate disparities and achieve equity. This workshop will shed a light on the use of community health workers and health leads advocates to address social determinants and improve access to care, with a particular focus on improving the care of diverse populations. In addition to providing an overview of this work, the presenters will share the business case, and the return-on-investment for their initiatives.
Grounding Session II Making HIT Meaningful: Identifying and Addressing Disparities in the Digital Age Panelists: John Halamka, MD, MS, Chief Information Officer, Harvard-Beth Israel Deaconess Medical Center Joseph Kvedar, MD, Founder and Director, Center for Connected Health, Partners HealthCare
Moderator: Lenny Lopez, MD, MDiv, MPH, Senior Faculty, the Disparities Solutions Center Health information technology (HIT) has emerged as a cornerstone of health care reform, and as a crucial tool for payment reform. The march towards meaningful use is steadily advancing, and the promise of quality improvement, efficiency, and cost savings is driving the nation to solidify its health information infrastructure at a rapid pace. While there is excitement about the implementation and expansion of the capacities of the electronic medical record and decision support; the capacity to support population management as a vehicle for improving screening rates and manage chronic disease; and the use of innovative technologies such as remote monitoring, telemedicine, and text messaging—several question remains. Will HIT be deployed to meet the needs of diverse populations? If so, how? How can HIT be applied to assist in efforts to eliminate disparities? As we move towards meaningful use, how will disparities requirements fit in? Presented by two of the foremost experts in HIT—one focusing on meaningful use and disparities, the other on innovative HIT approaches to improving care and care management—this panel will highlight the role of the electronic health record, and promising and novel methods of deploying HIT, to address disparities and achieve equity.
Enjoy refreshments and light hors d'oeuvres as we end the first full day of the Forum with a fun and casual reception and live music. Connect and network with colleagues and experts working to advance health equity. The reception will also showcase Disparities Leadership Program alumni work in disparities and equity. Posters will remain on display during the reception as well as the lunch session on day 2.
Grounding Session III Seeking diverse perspectives:Identifying and Improving Patient Experience Panelists: Karen Donelan, EdM, ScD, Senior Scientist, Mongan Institute for Health Policy, Massachusetts General Hospital Kathryn Coltin, MPH, Director of External Quality Data Initiatives, Harvard Pilgrim Health Care
Moderator: Joseph Betancourt, MD, MPH, Director, the Disparities Solutions Center In the current environment of health care transformation and a focus on value, getting a better understanding of patient experience in hospitals and member experience with health plans has become more important than ever before. Whether used for public reporting, quality improvement, patient/member choice, or rewarding performance, there is no doubt that patient experience matter. Research in the area of patient experience has documented two important issues, however. First, the methods and tools that are currently used to measure patient experience may leave some voices in the dark and as a result may not be truly representative of the experiences of all patients. Second, there appear to be variations in patient experience, and patient perspectives about care, by race and ethnicity. This session will highlight an innovative strategy undertaken by a hospital to better identify the experiences of minority patients, and the approach a health plan has taken to stratify their experience scores by race and ethnicity. The expert presenters will share their lessons learned, and provide guidance on how to better identify and improve the experience of diverse patient populations.
Workshop C* Discharge Planning 2.0: Preventing Readmissions in Diverse Populations Panelists: Suzanne Mitchell, MD, MS, Assistant Professor, Family Medicine, Boston University School of Medicine Bev Beckman, RN, CPHQ, ACM, Project Manager, Upstream to Equity and Compassionate Care for Vulnerable Populations Project, Jewish Hospital and St. Mary’s Healthcare
Moderator: Alexander Green, MD, MPH, Associate Director, the Disparities Solutions Center Improving transitions of care and preventing readmissions are important new parts of the value-proposition for hospitals and health plans. Given the financial disincentives for readmissions within thirty days for patients with acute myocardial infarction, congestive heart failure and community acquired pneumonia (and soon chronic obstructive pulmonary disease and total hip replacement), healthcare organizations are developing a portfolio of activities to improve communication and care coordination at discharge. Few of these efforts, however, have focused on the specific needs of diverse populations, including patients with limited health literacy, English-proficiency, or resources at home, among other vulnerabilities. This presentation will showcase the latest in efforts to prevent readmissions in culturally diverse and limited-English proficient patient populations. The two presenters—one who was part of the development team who created the nationally renowned Project RED (Reengineered Discharge) Toolkit that focused particularly on minority and vulnerable populations, and one who has implemented a successful program to decrease readmissions with a focus on equity of care—will share their approaches, lessons learned, and guidance for success in this area.
Workshop D* Tracking Equity: New Frontiers in Data Collection Panelists: Andrea Crowley, MBA, Senior Manager, Business Services Division of Admitting and Registration Services, Massachusetts General Hospital Zary Amirhosseini, M. Ed., Disability Program Manager, Office of Patient Advocacy, Massachusetts General Hospital Caroline Bennett-AbuAyyash, PhD, Health Equity Project Coordinator, Mount Sinai Hospital Stephanie Gee, MA, Senior Project Manager, Research and Evaluation, The Hospital for Sick Children
The foundation of all efforts to identify disparities, improve quality, achieve equity and deliver value is effective data collection. This is particularly critical in the current age of “big data” in health care, where we are trying to better understand who our patients are, and what their needs may be, as we develop registries for population health, and dashboards to monitor and report our performance. Despite this, health care organizations across the country are still struggling to collect the race, ethnicity, and language of their patients—as recommended by the Institute of Medicine Report Unequal Treatment. However, several have distinguished themselves in this area, collecting not only race, ethnicity and language, but also tailoring these tools for pediatric populations, and collecting data on sexual orientation and disability. This panel of experts have all been involved, on-the-ground, on these efforts and will share lessons learned and key success factors from their experiences, as well as highlight new cutting edge approaches to capturing additional data for pediatric populations, LGBT populations, and those with disabilities.
Workshop E* New Tools and Interprofessional Teams: Preventing Medical Errors in Patient with Limited-English Proficiency Panelists: Anabela Nunes, MBA, Director of Medical Interpreter Services, Massachusetts General Hospital Alexander R. Green, MD, MPH, Associate Director, The Disparities Solutions Center, Massachusetts General Hospital
Moderator: Alden Landry, MD, MPH, Senior Faculty, the Disparities Solutions Center Safety is a key component of quality, and given health care organization are at risk for financial penalties when errors—and particularly never events occur—advances in this field have become an essential component of healthcare transformation. Research demonstrates that minorities and patients with limited-English proficiency suffer more medical errors with greater clinical consequences than their white counterparts. Certain communication sensitive, high-risk scenarios have been identified, such as those related to medication reconciliation, discharge instructions, informed consent, and surgical instructions, to name a few. As of recently, however, there had been no specific guidance or tools to assist healthcare organizations to prevent medical errors in patients with limited-English proficiency. With support from the Agency for Healthcare Research and Quality, a Hospital Guide and Team STEPPS training module have been developed for exactly this goal. In addition, with support from the Macy Foundation, an e-learning program was developed for doctors and nurses that promotes the use of interprofessional teams to improve the safety of diverse patient populations. This presentation, by the experts who created these tools and have implemented their recommendations in a real-world setting, will highlight key approaches and lessons learned from their work.
The activities reported here were supported (in part) by the Josiah Macy Jr. Foundation and the Office of Minority Health at Centers for Medicare and Medicaid Services.
Workshop F* Giving the Patient A Voice: Health Literacy and Patient Engagement as a Path to Equity Panelists: Michael Paasche-Orlow, MD, MPH, MA, Associate Professor of Medicine, Boston University School of Medicine Nancy Rothman, EdD, RN, Director of Community Based Practice, Temple University
Moderator: Lenny Lopez, MD, MDiv, MPH, Senior Faculty, the Disparities Solutions Center Health literacy, patient engagement and shared decision making are all part of a bold new effort to truly deliver on the quality principle of patient-centeredness, and facilitate the activation and partnership of patients in their own care. As our health care system moves to greater choice, transparency, and personal responsibility, the patient will need to have a voice, and know how to use it effectively to make their own decisions and promote their care and wellbeing. While these goals may be challenging to achieve in general, they may be especially difficult in minority patients, and for those individuals who come from cultures where being active in the clinical encounter is neither expected, promoted, nor is the norm. To achieve the promise of equity, we must assure that all patients feel comfortable being active partners and participants in their care, and that we have the tools and know-how to empower them to do so. This presentation, by experts who have worked with minority and vulnerable populations in the areas of health literacy and patient engagement, will provide important insights and strategies on how we can assure that all patients are informed, activated consumers and participants in health care.
Lunch Session The Road Behind and the Journey Ahead: Equity, Quality, and the Keys to Success Keynote Speaker: Carolyn Clancy,MD, Assistant Deputy Under Secretary for Health for Quality, Safety and Value (10A4), Veterans Health Administration, Former Director of AHRQ
Respondents: Michael Currie, MBA, MPH, Director, Health Equity Service Program, UnitedHealthcare Elizabeth Mort, MD, MPH, Senior VP of Quality and Safety, Massachusetts General Hospital Wayne Rawlins, MD, MPH, National Medical Director, Racial and Ethnic Quality Initiatives, Aetna
Moderator: Joseph Betancourt, MD, MPH, Director,the Disparities Solutions Center
The road to quality care has been long and winding, but we have finally arrived at a place where we are walking-the-walk and building a payment system that will reward performance, not just volume—and measures that will hold healthcare organizations accountable. There is no doubt that we have learned a lot along this journey, and there is much more to learn. As we aim to keep equity central to the conversation of value, quality, and health care transformation, it is important to identify some key trends that have emerged across the nation that might serve as critical success factors going forward. Drawing on her extensive experience in the field, this session will provide a look back at how equity has become an essential component of quality, what we’ve learned along the way, and what it will take to successfully deliver value in the care of diverse populations.
Grounding Session IV Making the Connection: Oral Health and the link to Population Health Management Panelists: Cynthia Hodge, DMD, MPH, MPA, President, National Dental Association Foundation David E. Miller, DDS, Chief, Division of Oral Health, Illinois Department of Public Health Zoila Torres Feldman, RN, MS, Chief Expansion Officer, North End Waterfront Health
Moderator: Alexander Green, MD, MPH, Associate Director, the Disparities Solutions Center
The area of population health management will benefit from heavy investments as part of health care reform and payment reform. The hope is that our nation will finally be able to devote the necessary resources to systematically focus interventions on those individuals and those conditions that are most prevalent, disabling, and costly. The obvious suspect conditions that seem to be emerging include cardiovascular disease, diabetes, and asthma. A longstanding and growing area of research has indicated, however, how important oral health is to the successful management of these chronic diseases. Despite this, little attention and few resources have been devoted to better incorporating oral health interventions as part of chronic disease management. Going forward, successful population health efforts cannot leave oral health by the wayside. Those that plan well will determine how to integrate oral health into these efforts. This presentation will highlight the key evidence on the impact of oral health on chronic disease, and present ideas and perspectives on how these areas can be integrated into population health management.
Grounding Session V Addressing Disparities, Improving Quality and Delivering Value: A Roundtable on the Road Ahead Panelists: Sarah Rafton, MSW, Director, Center for Diversity and Health Equity, Seattle Children’s Hospital Mini Swift, MD, MPH, FACP, Assistant Chief Medical Officer, Medical Director of Health Equity and Utilization Care Management, Alameda Health System Pam Siren, RN, MPH, Vice President of Clinical Quality Operations, Health Partners Plan Kris McCracken, MBA, CEO, Manchester Community Health Center Juana Slade, CDM, CCF, Director of Diversity and Language Services, AnMed Health
Moderator: Joseph Betancourt, MD, MPH, Director, the Disparities Solutions Center
The road to disparities solutions can be long and windy, but there is a tried and true blueprint. Strategic planning serves as the map, data collection the foundation, performance monitoring the measurement stick, and interventions to eliminate disparities the ultimate goal. There is no doubt that organizations—depending on leadership, resources, expertise—are in different stages of this journey. This panel—composed of health plan, hospital, and community health center leaders who have tackled disparities—will share their candid thoughts about experiences about the successes and challenges they’ve faced along the way. They will also share lessons learned, and provide strategies to facilitate change and success. Although they are still on the long and winding road, they have all made progress and will openly share what they have learned.
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