H E A L T H W E A L T H C A R E E R

M E R C E R W E B C A S T

I M P A C T I N G T H E H E A L T HO F Y O U R H I S P A N I CE M P L O Y E E S : D I S P A R I T I E S ,C O S T S , T R E N D SJULY 26, 2016

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T O D AY ’ S S P E A K E R S

DR. DIEGO RAMIREZMercer Global Health Management Consultant

Diego is a Global Health Management Consultant with more than 14 years of global experience. Diego worked inMexico developing health management practices for the Latin America region, including wellness programs, benefitsdesign, onsite clinic implementation and ROI studies. Diego leads Mercer’s initiatives in the area of innovative healthmanagement solutions. These focus on healthcare aspects such as diversity, women’s healthcare, LGBT benefits, elderemployee care and job mobility. Diego is a Doctor of Medicine and has two master’s degrees. One of these degrees is inHealth Administration and the other is in Strategic Marketing, currently he is based in San Francisco.

DR. JOSEPH R. BETANCOURT, MD, MPHDirector, The Disparities Solutions Center

Dr. Betancourt is also the Senior Scientist at the Mongan Institute for Health Policy, Director for Multicultural Education atthe Massachusetts General Hospital and Associate Professor of Medicine at Harvard Medical School.Dr. Betancourt received his Bachelor of Science from the University of Maryland, his medical degree from Rutgers-NewJersey Medical School, and completed his residency in Internal Medicine at the New York Hospital-Cornell MedicalCenter. Following residency, he completed The Commonwealth Fund-Harvard University Fellowship in Minority HealthPolicy, and received his Master’s in Public Health from the Harvard School of Public Health.

DR. ALFREDO RATNIEWSKIBorrego Community Health Foundation Chief Medical Officer

Dr. Ratniewski is also the Medical Advisor to ConsejoSano. Borrego network of clinics serves a mostly Hispanicpopulation and includes 6 clinics founded by Alfredo, which he later sold to the larger Borrego organization.He is a Professor in the Department of Community and Family Medicine at the University of California, San Diego andmember of the California Medical Association, the San Diego County Medical Society, a Fellow of the American Collegeof Physicians, and the American College of International Physicians.

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A G E N D AW H A T W E ’ L L C O V E R T O D AY

• A Business Imperative: Context for Employers

• An Academic Perspective: Improving Quality and Achieving Equity – Disparities in Healthcarefor Hispanics and Hispanic issues

• Patient Perspective: Today’s Experience

• A Solution: ConsejoSano & Mercer Alliance

• Q&A

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A BUSINESS IMPERATIVECONTEXT FOREMPLOYERS

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D I V E R S I T Y & I N C L U S I O NC R E A T E A N I N C L U S I V E W O R K F O R C E T O D R I V ES T R O N G E R B U S I N E S S O U T C O M E S• An inclusive organization:

– Drives innovation and business success by respecting, valuing, and leveragingindividual differences

– Offers a competitive advantage that differentiates teams, products, services, and solutions– Helps people recognize, understand, and believe in a broad set of diverse dimensions

Gender

Race

LGBTDisabled

AgeDiverse

Workforce

Focused &deliberate change

management

R I G H T T H I N G T O D O A B U S I N E S S I M P E R A T I V E

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65% of Hispanics speakSpanish in the home

22 million HispanicEmployees and growing

In 2050 the US will be thelargest Spanish-speaking

country in the world

17% of the total population in the U.S. is Hispanicbut only 5% of doctors speak Spanish

T H E C O N T E X T:A S L E E P I N G G I A N T – D E M O G R A P H I C N E C E S S I T Y

Million HispanicsIn the U.S.

LargestSpanish-speaking

country

#254

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U.S. Workforce Hispanic Employees

Preferred source of treatment Professional healthcare provider Advice from family, self care ortraditional medicine

Knowledge of U.S. healthcare system Sufficient to get care Basic or non-existent

Prevention and lifestyle Health insurance covers prevention andaccess to health information

No insurance or preventive care notcovered, limited access to healthinformation

Interaction with healthcare providersExpertise higher priority thanrelationship –15 minute visit

Trust and relationship priority –60–90 minute visit

Pharmaceuticals Prescription required for many drugsand used to using them

Prescription not required for manydrugs, used to OTC or home remedies

H I S P A N I C E M P L O Y E E V I E W O N H E A L T H C A R E

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AN ACADEMICPERSPECTIVE:IMPROVING QUALITY ANDACHIEVING EQUITY

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H I G H - V A L U E I N A T I M E O FH E A L T H C A R E T R A N S F O R M A T I O N

Value-based purchasing and health care reform will alter the way health care isdelivered and financed; quality not quantity…

Increasing Access: Assuring appropriate utilization

• Linking to the PCMH, decreasing ED use & avoidable hospitalizations

Improving Quality: Providing the best care

• Importance of Wellness, Population Management

Controlling Cost: Focusing on the Pressure Points

• Importance of hot spotting and preventing readmissions, avoiding medical errors,and improving patient experience

• Banding together and risk-sharing through ACO’s

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I N C R E A S I N G D I V E R S I T Y

Health care organizations need to prepare staff to work with patients and colleaguesfrom diverse cultural backgrounds

White,72%

AfricanAmerican,

12%

Latino,11%

AsianAmerican,

4%

NativeAmerican,

1%

1 9 9 8

C U R R E N T AN D P R O J E C T E D R E S I D E N T P O P U L AT I O N O F T H E U N I T E D S TAT E S

White,60%

AfricanAmerica,

13%

Latino,19%

AsianAmerican,

7%

NativeAmerican,

1%

2 0 3 0

1. Collins KS et al. US Minority Health: A Chartbook, Vol. 11. New York, NY: The Commonwealth Fund:1999.

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D I A B E T E S - R E L A T E D D E A T H R A T E , 2 0 1 4D E A T H S P E R 1 0 0 , 0 0 0 P O P U L A T I O N

22.8

50.1

33.6

50.3

18.4

0

10

20

30

40

50

60

WHITE BLACK HISP/LTN AI/AN ASIAN/PI

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W H A T C A U S E S T H E S E R A C I A L / E T H N I C D I S P A R I T I E SI N H E A L T H ?

• Social Determinants

• Access to Care

• Health Care

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R A C I A L A N D E T H N I C D I S P A R I T I E S I N H E A L T H C A R EA H I G H - V A L U E T A R G E T

• Racial/Ethnic disparities found across a widerange of health care settings, disease areas,and clinical services, even when variousconfounders (SES, insurance) controlled for

• Many sources contribute to disparities – noone suspect, no one solution– Navigation– Communication– Stereotyping– Mistrust

• Variations in care and quality, inefficiencies,costly care and poor outcomes are theepitome of low-value

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I O M ’ S U N E Q U A L T R E A T M E N TR E C O M M E N D A T I O N S

• Increase awareness of existence of disparities

• Address systems of care– Support race/ethnicity data collection, quality improvement, evidence-based

guidelines, multidisciplinary teams, community outreach– Improve workforce diversity– Facilitate interpretation services

• Provider education– Health Disparities, Cultural Competence, Clinical Decision-making

Patient education, navigation, activation

• Research– Promising strategies, Barriers to eliminating disparities

www.nap.edu

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A V I E W F R O M T H E F I E L D

• Based on MGH and Disparities Leadership Program Data Collection (race/ethnicity,language, education, other)– 312 Individuals, 142 organizations, 77 hospitals, 45 health plans, 31 States

• Performance Measurement and Monitoring– Dashboards, Annual Reports that stratify quality measures

• Interventions– Interpreter Services– Cross-Cultural Communication Training of Doctors, Nurses, Staff– Health Care Coaches, Navigators, Community Health Workers

- Focus on Wellness, Population Health, Readmissions, ED Use, AvoidableHospitalizations

- Limited resources to meet needs of growing Latino population

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P R E P A R I N G F O R T H E F U T U R E

• Addressing variations in quality – such as racial/ethnic disparities in health care –will be essential going forward if we are to achieve equity, high-performance andhigh-value

• This is not just about equity for equity’s sake – cost is key – as equity connects to allareas of quality:– Population Management– Transitions of Care and Readmissions– Appropriate Utilization and Avoidable Hospitalizations– Patient Safety– Patient Experience

• Healthcare organizations ignore this at their own peril… action will separate winnersfrom losers…

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HISPANIC PATIENTEXPERIENCE TODAY

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DR ALFREDO to speakto his real-world

experience of hispanicpopulation in US and

Mexico

T H E P A T I E N T E X P E R I E N C E

Language

Culture

Values

Trust

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What is ConsejoSano?ConsejoSano = Culturally relevant health engagement for Hispanics

ConsejoSano is the leading Hispanic healthplatform that helps Spanish speaking employeesincrease their health by offering culturally andlinguistically relevant health services.

We help companies effectively engage andcommunicate with their Hispanic employees,while helping them navigate the U.S. healthsystem and change behaviors to lower costs.

Trusted Telehealth Services for Spanish Speakers

General MedicalAdvice 24/7

Diabetes, WeightLoss and Nutrition

Emotional Support& Stress

Navigate U.S.Health System

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Q&A

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Q U E S T I O N S ?

DR. ALFREDO RATNIEWSKIDR. DIEGO RAMIREZ JOSEPH R. BETANCOURT MD, MPH

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