The Use of Indirect Race and Ethnicity Data in Reducing Health Disparities: A Healthplan Model...
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Transcript of The Use of Indirect Race and Ethnicity Data in Reducing Health Disparities: A Healthplan Model...
The Use of Indirect Race and Ethnicity Data in Reducing Health Disparities:
A Healthplan Model
Diversity RxOctober 20, 2010
Peggy Payne, MA, CDE
CIGNA
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© 2010 CIGNA
Mission: To help the people we serve improve their health, well-being and sense of security
Customers: 46 million customers worldwide
History: 1792 Insurance Company of North America1865 Connecticut General Life Insurance Company1982 Connecticut General and INA form CIGNA
Team: 25,000 Employees WorldwideHeadquarters: Philadelphia, PA
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About CIGNA
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© 2010 CIGNA
What are health disparities?
Meaningful differences in the health status (risk, prevalence, outcomes, etc) of one sub-population compared to another
No single operational definition, many factors to consider and many ways to look at the data
We focus on percent differences among racial/ethnic groups using the group with the most favorable rate/outcomes as the point of comparison1
1http://www.cdc.gov/nchs/data/series/sr_02/sr02_141.pdf
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© 2010 CIGNA
Why are health plans interested in demographic data?
To know our customers to provider superior customer service
To identify need for customized interventions
To develop targeted communications
To add meaning to our outcomes
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© 2010 CIGNA
Spectrum of Difficulty in Defining, Collecting and Understanding Demographic Data
Gender, Age
Most universal descriptors
Collect at enrollment
Location
Useful for examining regional differences
Mailing address collected at enrollment, not 100% accurate
P.O. boxes limit the precision
Race/Ethnicity
Most common descriptor -health disparities
Limited collection; not collected at enrollment
Can be indirectly estimated based on home address and last name
Social/Cultural
Income, education, urban/rural, etc.
significant implications on underlying causes and opportunities for intervention, not collected
Can be estimated based on home address, difficult to assess reliability with no ‘true’ data available for validity checks
Easy Challenging
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© 2010 CIGNA
The RAND Model2
Uses address and last name by combining the race/ethnicity distribution of where a person lives (census block or tract data) with the race/ethnicity distribution of people with the same last name to determine the probability of a person belonging to each OMB category
The estimates only work aggregated for a population and have limited use at individual level.
How is it possible to estimate race/ethnicity?
1 Office of Management and Budget (OMB) http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=172
2 http://www.rand.org/pubs/external_publications/EP20060804/
OMB Race/Ethnicity Categories1: American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic or Latino
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© 2010 CIGNA
So what is CIGNA doing with the data?
Analysis– Examining our utilization and HEDIS measures
to identify disparities by race/ethnicity.
– Using Hispanic/Latino ethnicity as a proxy for Spanish language to estimate volume of Spanish-speaking.
Action– Creating pilot initiatives to address disparities identified.
– Training staff to be culturally sensitive.
– Mobilizing staff with knowledge of a specific racial/ethnic culture to serve a subject matter experts to guide the development of culturally-sensitive materials and interventions.
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© 2010 CIGNA
Lessons Learned
Understand the people behind the numbers.
Race/ethnicity estimates are just that – estimates.
Measure twice, cut once.
Looking at the data from multiple angles will lead to a more informed conclusion and the most effective allocation of resources.
Don’t outsmart your common sense.
A large percent difference observed among various groups doesn’t necessarily mean that action is required.
Questions?Peggy Payne
[email protected] 949.709.1119
“CIGNA” and the “Tree of Life” logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. All products and services are provided exclusively by such operating subsidiaries, including Connecticut General Life Insurance Company and CIGNA
Health and Life Insurance Company and not by CIGNA Corporation.