Our Commitment to Reducing - AetnaUnequal Treatment: Confronting Racial . and Ethnic Disparity. in...

Our Commitment to Reducing Disparities in Health Care

Aetna’s Racial and Ethnic Equality Initiative

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Impact of Racial and Ethnic Disparities in Health Care

History of Racial and Ethnic Equality Chairman’s Initiative

Data Collection Methods / Analytical Tools and Output

Putting the Data to Work

Awards and Recognition

Key Messages

Today’s AgendaAetna’s Racial & Ethnic Equality Initiative

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Aetna’s commitment is articulated by senior management, reinforced through the business planning process, and is strongly linked to company strategy and individual rewards

Our embrace of all types of diversity is the underpinning of Aetna’s commitment to the goal of racial and ethnic equality in health care

Aetna’s commitment to equality is informed by our values

Aetna’s Racial & Ethnic Equality Initiative

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Impact of Racial and Ethnic Disparities in Health Care


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Disparities in health care are indisputable

Institute of Medicine Report

Unequal Treatment: Confronting Racial and Ethnic Disparityin Health Care (2002)

Harvard School of Public Health and the Robert Wood Johnson FoundationAmericans’ Views of Disparities in Health Care (2005)

Agency for Healthcare Research and QualityNational Healthcare Disparities Report (2010)

Journal of the American Medical AssociationResident Physicians’ Preparedness to Provide Cross-Cultural Care (2005)

Morbidity and Mortality Weekly ReportCDC Health Disparities and Inequalities Report - United States (2011)


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Disparities in health care are indisputable

National Business Group on Health

Members of racial and ethnic minority groups in the United States often receive lower quality health care than do their white counterparts (2009)

Direct medical costs due to health inequities were more than $230 billion over a 4 year period Joint Center for Political and Economic Studies – LaVeist, et al, (2009)

In 2009 private insurers will incur $5.1 billion in additional costs due to elevated rates of chronic illnessThe Urban Institute – Waidmann, T., (2009)

ECONOMIC IMPACT OF DISPARITIES


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Hispanic DisparitiesAetna’s Racial & Ethnic Equality Initiative

Puerto Ricans have the highest asthma prevalence of any Hispanic population1

In 2005, Hispanic women were twice as likely to be diagnosed with cervical cancer2*

In 2006, Hispanics were 1.5 times more likely to die from diabetes3*

Mexican American women are 1.3 times more likely to be obese4*

*compared to non-Hispanic whites1Source: National Health Interview Survey, National Center for Health Statistics, CDC.2,4Source: US Department of Health and Human Services, Office of Minority Health3Source: CDC, 2009. Health United States, 2008. Table 54

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African American DisparitiesAetna’s Racial & Ethnic Equality Initiative

African Americans have the highest mortality rate for all leading causes of death of any racial and ethnic group1

On average, African Americans are twice as likely to have diabetes2*

African Americans are 1.5 times as likely to have high blood pressure3*

In 2005, African Americans had 2.3 times the infant mortality rate4**compared to non-Hispanic whites

1Source: US Department of Health and Human Services, Office of Minority Health2Source: CDC, 2010. Health United States, 2009. Table 513Source: CDC, 2010. Health United States, 2009. Table 684Source: CDC, 2010. Infant Mortality Statistics from the 2006 Period Linked Birth/Infant Death Set. National Vital Statistics Reports. Table 2

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Asian / Pacific Islander DisparitiesAetna’s Racial & Ethnic Equality Initiative

Asian Americans are the only racial / ethnic group to have cancer as the leading cause of death1

Chinese Americans are 6 times more likely to die of liver cancer2*

Native Hawaiians have more than twicethe rate of diabetes3*

Asian Americans account for over half the deaths from chronic hepatitis B infections4

*compared to non-Hispanic whites

1Source: CDC, Office of Minority Health & Health Disparities, 20062Source: President’s Advisory Commission on Asian Americans and Pacific Islanders, Asian Americans and Pacific Islanders Addressing Health Disparities. Opportunities for Building a Healthier America, 20033Source: US Department of Health and Human Services, Office of Minority Health4Source: CDC, National Center for Infectious Diseases (NCID), Hepatitis B and Asian Americans Fact Sheet

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American Indian / Alaska Native DisparitiesAetna’s Racial & Ethnic Equality Initiative

American Indian / Alaska Native menare 1.8 times as likely to have stomach cancer and are over twice as likely to die from it1*

American Indian / Alaska Native adults were 2.3 times as likely to be diagnosed with diabetes2*

American Indian / Alaska Native adults are 1.6 times as likely to be obese3*

American Indian / Alaska Natives have 1.5 times the infant mortality rate4*

*compared to non-Hispanic whites

1Source: US Department of Health and Human Services, Offices of Minority Health2Source: CDC 2005. Health Characteristics of the American Indian and Alaska Native Adult Population: United States, 1999-2003, Advance Data (356), Table 43Source: CDC 2005. Health Characteristics of the American Indian and Alaska Native Adult Population: United States, 1999-2003, Advance Data (356), Table 24Source: CDC 2010. Infant Mortality Statistics from the 2006 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports. Table 1.

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Distribution of U.S. Population by Race/ Ethnicity, 2010 and 2050


NOTES: All racial groups non-Hispanic. Data do not include residents of Puerto Rico, Guam, the U.S. Virgin Islands, or the Northern Marina Islands. Totals may not add to 100%.

SOURCE: Kaiser Family Foundation, based on http://www.census.gov/population/www/projections/downloadablefiles.html U.S. Census Bureau, 2008, Projected Population by Single Year of Age, Sex, Race, and Hispanic Origin for the United States: July 1, 2000 to July 1, 2050.

WHITE

HISPANIC

AFRICAN AMERICAN

ASIAN

NATIVE HAWAIIAN/PACIFIC

ISLANDERAMERICAN

INDIAN/ALASKA NATIVETWO OR

MORE RACES

64.72010 16 12.2 4.5

.1

.8

1.5

46.32050 30.2 11.8 7.6

.2

.8

3.0

0% 100%50%

http://www.census.gov/population/www/projections/downloadablefiles.html

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History of Racial and Ethnic Equality Chairman’s Initiative


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Racial and Ethnic Equality Historical Timeline

Reconstitution of Racial and Ethnic Equality External Advisory Committee (‘07) with on-going meetings

Hypertension in African Americans Study

African American Diabetes Education Pilot

Breast Health Ethnic Disparity Initiative

Latino Diabetes Study

Hypertension in African Americans Study PUBLISHED

Development & launch Asthma ER UtilizationPilot

Provider-focused Diabetes Initiative

Racial and Ethnic Equality Data Available

ERG Survey completed and feedback built into engagement strategy

Employee Resource Groups (ERG) Focus Groups held

Racial and Ethnic Equality Dashboard Report createdwith annual refresh

2006 2007 2008 2009 2010

27.8% members reporting





Cultural competency training available for network providers

Since 2001 Aetna Foundation has awarded more than $30 million to support initiatives to reduce racial and ethnic health disparities


Beginning Right Program begins in 2002

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Data Collection Methods, Analytical Tools and Output


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Safeguarding the Data – Our Commitment to our Members

Aetna was one of the first health plans to gather self reported information on race, ethnicity and language preference

Information helps us understand members’ wellness and health care needs


Privacy of member data isstrictly safeguarded

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Aetna Navigator®

Data Collection begins

Member Participation


50%

40%

30%

20%

10%

0

2002 2003 2004 2005 2006 2007 2008 2009 2010

<1% 1.1%

9.6%

19%

27.8%

34.5%37.6%

34.5% 34.6%

Percentage of members with medical insurance who self-identify

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Mining the Data – Racial and Ethnic Equality Dashboard

INFORMATION DASHBOARDhelps us analyze Racial and Ethnic Equality (REE) dataCombines Aetna’s data, e.g., demographics, racial and ethnic information provided by our members, claims, laboratory and pharmacy

Disease prevalence

Geography

Segment and Product

Consumer Assessment of Healthcare Providers and Systems results (CAHPS®) (Consumer Satisfaction)Stratified by race and ethnicity

DASHBOARD ELEMENTS:

Quality measuresAsthma careDiabetes careMaternal and child healthCardiac/vascular careCancer screeningBehavioral health


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With HbA1c > 9(poor control)

100%

50%

With at least one HbA1c within 1 year

With HbA1c < 7(good control)

Non-Hispanic whites African American Hispanic

Asianp=<.0001 compared to Non-Hispanic whites

Note: HbA1c or Glycosolated Hemoglobin is a measure of plasma glucose (sugar)and is an assessment of diabetic control

Racial and Ethnic Equality Dashboard Report - 2008

REE DASHBOARD

Quality Measures - DIABETES


82.2 79.682.3

10.6

20.8 20.8

9.3

77.8

57.8

46.7

54.6

47.3

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Impact of Disparities on Asthma ER Utilization



180

160

140

120

100

80

60

40

20

0

51.4

170.1

97.4

Annualized ER Visits/1000


p=<.0001 compared to Non-Hispanic whites

Asthma ER Utilization(18 Years of Age and Older)

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Significant Economic Impact of Disparities in Asthma ER Utilization



180

160

140

120

100

80

60

40

20

0

Annualized ER Visits/1000


p=<.0001 compared to Non-Hispanic whites

$121,000 per1,000 Members

$47,000 per1,000 Members

Asthma ER Utilization(18 Years of Age and Older)

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Putting the Data to WorkImproving health with information


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Addressing Differences in Care

CURRENT PROGRAMS

Breast Health Ethnic Disparities Initiative

Beginning Right Maternity Program

Care Considerations

PUBLISHED STUDIESHypertension in African Americans Study

INITIATIVES IN PROGRESS

Provider Focused Diabetes Initiative

Asthma ER UtilizationInitiative


PUBLICATIONS IN PROGRESSRacial and Ethnic EqualityDashboard Report

Understanding the EconomicImpact of Emergency Room Utilization in Minority Asthmatic Populations in a Managed Care Environment

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CURRENT PROGRAMS


1 Centers for Disease Control http://www.cdc.gov/cancer/dcpc/data/ethnic.htm - 20062 Center for Disease Control http://www.cdc.gov/cancer/breast/statistics/screening.htm - 2005

African American and Hispanic women who get breast cancer are more likely to be diagnosed at a later stage of the disease than white women

Only 59% of Hispanic women age 40+ have regular screening mammograms compared to 67% of white women2

African American women have the highest mortality rate from breast cancer1

Breast cancer is the leading cause of cancer death among Hispanic women1

THE DATA


http://www.cdc.gov/cancer/dcpc/data/ethnic.htm

http://www.cdc.gov/cancer/breast/statistics/screening.htm

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Understand barriers to screening mammograms

Increase rate of screening mammograms

Determine if changing outreach methodology improves mammography screening rates

Three Arm Study

no outreach

culturally competent educational letter

culturally competent educational letter AND telephonic outreach

Changing outreach IMPROVES screening ratesno outreach

20.9%culturally competenteducational letter

23.8%culturally competenteducational letter ANDtelephonic outreach

27.6%

GOALS INTERVENTION RESULTS

CURRENT PROGRAMS



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CURRENT PROGRAMS


THE DATA

African American women have consistently higher rates of premature infants than do non-Hispanic white women1

African American women have higher infant mortality rates than do non-Hispanic white women2

Studies suggest that African American women do not receive the same pre-natal education as non-Hispanic white women, even when insured at the same level3

1 Ventura SJ, Martin JA, Currin SC, Menacker F, Hamilton B. Final data for 1999. National Vital Statistics Report 2001: 49:78-92 MMWR Weekly, February 11, 2005 / 54(05); 1263 Kogan MD, Alexander GR, Kotelchuck M, Nagey DA, Jack BW. Comparing Mothers Report on the Content of Prenatal CareReceived with Recommended National Guidelines for Care


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Educate women during pregnancy regarding risk of pre-term delivery and proper nutrition

Help women better communicate with their physicians

Increase the number of high risk women having full term pregnancies

Case manager assigned to follow through pregnancy and post-partum

Home delivered pre-term labor education program

“Generations”* book providing cultural competent information on pre-term delivery and nutrition

High risk women not enrolled in the pre-term labor program had fewer full term deliveries

High risk women enrolled in the pre-term labor program had a trend toward near full term and full term deliveries


CURRENT PROGRAMS



*“Generations” - Black Infant Mortality Reduction Resource Center (an affiliate of the Northern New Jersey Maternal / Child Health Consortium)

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Care Considerations are clinical alerts sent to physicians and members based on highly respected sources of evidence-based medicine that identify gaps in care, medical errors and quality issues.

Examples of Care Considerations for racial and ethnic minorities include:

Condition-specific clinical reminders for sickle cell disease in African Americans

Medication therapy reminder for chronic heart failure in African Americans

Screening reminder for Asian patients with hepatitis B who have a high risk for liver cancer


CURRENT PROGRAMS

Care Considerations

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PUBLISHED STUDIES

Hypertension in African Americans

1Archives of Internal Medicine, 19972AHA 2001 Heart and Stroke Statistical Update3Southern Medical Journal, 2000

Compared to Whites, African Americans have a higher prevalence of hypertension1,2

African Americans also have higher rates of cardiovascular mortality, stroke, hypertension- related heart disease, congestive heart failure, hypertensive nephropathy, and end stage renal disease1,2

African Americans have an 80% higher rate of stroke mortality, 50% higher rate of heart disease mortality, and 320% higher rate of hypertension- related end-stage renal disease3

THE DATA


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Increase the rate of clinically acceptable blood pressure measurements among African American members

Measure the impact of intervention on blood pressure and self care knowledge and behaviors of a Culturally Competent Disease Management Program (CCDMP) relative to a Light Support Program (LSP)

Two arm study evaluating CCDMP and LSP disease management programCCDMP components include: culturally competent

mailings

outbound member care calls

physician cultural competency training

quarterly reporting to physicians

The CCDMP was effective in increasing the percentage of members with clinically acceptable blood pressure by 36% compared to the members in the LSP

PUBLISHED STUDIES

Hypertension in African Americans

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Aetna’s Racial & Ethnic Equality InitiativeINITIATIVES IN PROGRESS

Provider Focused Diabetes Initiative

MEASURES OFSUCCESS

IMPLEMENTATION

GOALTo improve diabetic control for African American and Hispanic patients in a large multi-specialty provider group in Dallas, Texas

INTERVENTIONA part-time Bilingual Diabetic Educator (Care Coordinator) to assist in diabetic education and coachingCulturally competent provider and patient education materials

Improvements in:HbA1c levels, cholesterol screening, blood pressure, protein in urine, medication adherence, smoking cessation, eye and foot exams, BMI

A 12-month initiative launched in October 2010

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Aetna’s Racial & Ethnic Equality InitiativeINITIATIVES IN PROGRESS

Asthma ER Utilization Initiative

MEASURES OFSUCCESS

IMPLEMENTATION

GOAL

INTERVENTION

Reduce Emergency Room (ER) utilization among African American and Hispanic members with asthma

Home based environmental assessment, culturally competent asthma education, appropriate use of an asthma action plan, telephonic nurse follow-up, physician engagement

Reduction in asthma ER visits, improvement in medication adherence and knowledge

A 12-month initiative launched in 1Q 2011

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Aetna’s Leadership EffortsAetna’s Racial & Ethnic Equality Initiative

Aetna’s activities have been recognized nationally by:

Academy for Health Equity

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The key is to understand:Aetna’s Racial & Ethnic Equality Initiative

The impact of health care disparities and the importance of eliminating these disparities

The importance of obtaining self identified race and ethnicity information

Aetna’s leadership approach in addressing racial and ethnic health care disparities

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