Getting Started

If you detect a problem or disparity, such as low utilization or a high proportion of patients missing appointments or not taking prescribed medications, it can be difficult to discover the source of the problem. Focus groups or surveys asking patients about their experiences can shed light on problems like these. Other sources of information include community advocates and leaders and other community organizations that can speak to the health care experiences of the target population. When cultures are different and language barriers exist, you may not find out unless you ask!

Steps to Quality Improvement > Implementation > Health Care Organization Solutions

Health care organizations never promote health care disparities; nevertheless, their structures, policies and procedures sometimes reflect hidden cultural biases that become visible only through investigation. Some barriers to care are relatively obvious, such as lack of interpreters or translated materials for limited English-proficient individuals, while others are less conspicuous. The U.S. health care system is complicated to navigate, regardless of one’s ethnic background or English language abilities, thus posing another barrier that is sometimes overlooked. Navigating a health plan’s networks, understanding the organization’s rules and getting referrals to and coordinating with various specialists—these can be complicated ventures even for native English speakers.

Organizations with strong information system resources may be able to enhance decision support systems available to practitioners by building prompts and reminders for practitioners related to preventive or follow up care. In the example of Blue Cross of California ²2. The National Committee for Quality Assurance (NCQA). Innovative Practices in Multicultural Health Care 2006. Available at http://Web.ncqa.org/Default.aspx?tabid=453. October 5, 2007. the health care organization was able to provide a real-time prompt to pharmacists for patients who filled a prescription for asthma rescue medicine after too few controller medications had been dispensed. Data collected from the consultation transaction database—including reasons why pharmacists did not perform consultations—were compared to pharmacy records with members’ self-reported race/ethnicity to show that eligible racial and ethnic minorities received fewer pharmacy consultations even though pharmacists were unaware of the disparity.

Other health care organizations use decision support systems to conduct targeted outreach for missed or delayed screening, prevention or follow up care. Aetna developed a culturally sensitive breast cancer screening initiative used to encourage mammography screening among its female African American and Latina members.³3. Ibid. Innovative Practices in Multicultural Health Care 2007. Available at http://Web.ncqa.org/CLAS.aspx, November 15, 2007.

Health plans may be able to reduce disparities by reducing or eliminating copayments for certain preventive care services or by altering referral or prior authorization requirements for specific types of care when these procedures are identified as significant barriers to care for certain populations. Some health plans offer incentives to patients instead. In its Shots for Shorties program, Molina Healthcare of Michigan offered free baby portraits to families that brought a child’s immunizations up to date by the child’s second birthday.²2. The National Committee for Quality Assurance (NCQA). Innovative Practices in Multicultural Health Care 2006. Available at http://Web.ncqa.org/Default.aspx?tabid=453. October 5, 2007. Other organizations are implementing pay-for-performance programs for providers that improve care.