Getting Business Support for Community Health Disparities Initiatives

1
Getting Business Support for Community Health
Disparities Initiatives
Lisa Egbuonu-Davis, MD, MPH, MBA Pfizer Scholar
in Residence Womens Research and Resource
Center Spelman College
2
Unequal Treatment Recommendations

• Increase public and provider awareness about
  disparities
• Change financial incentives to improve quality,
  decrease fragmentation of care
• Ensure provider supply, reduce barriers and
  promote quality evidence based practice
• Promote civil rights enforcement
  

3
Unequal Treatment Recommendations

• Promote provider training, cultural competence,
  translation services, community health workers
  and multidisciplinary teams
• Promote patient education to enhance access and
  participation in treatment decisions
• Collect data on access, utilization and quality
  including race/ethnicity/language and monitor
  progress
• Conduct more research on sources of disparities
  and interventions to reduce them

4
Potential Initiatives for Business Support

• Increasing Public Awareness
• Improving Care Access
• Workforce Diversity and Cultural Competency
• Health Literacy
• Patient Empowerment
• Community Health Workers
• Disease Management/Health Care Quality
  Improvement
• Research Support

5
Increasing Public Awareness

• The Employer Toolkit-Reducing Racial and Ethnic
  Disparities
• Developed by Pfizer with Washington Business
  Group on Health
• Currently a program of the National Business
  Group on Health
• Designed to raise corporate awareness about
  racial and ethnic health disparities,their impact
  and cost and to identify strategies for large
  employers to ensure equitable healthcare services
  for diverse populations
• Contains analyses and summaries of business case
  for employers, findings from national employer
  survey on racial and health disparities, fact
  sheets and strategies
• Winner of 2004 National Minority Health Months
  Health Promotion and Disease Prevention Award

6
Impact of Uninsurance

• Acutely ill receive fewer and less timely
  services and have worse health outcomes
• Chronically ill have fewer services, increased
  morbidity and worse outcomes
• Lower receipt of preventive and screening
  services
• Communities with higher rates of uninsured have
  reduced availability of health care services

Source IOM. Hidden Costs, Value Lost, June 2003.
7
Improving Access to Care

• Partnership for Prescription Assistance
• Joint program of pharmaceutical research and
  manufacturing association (PhRMA)
• Single source via web or phone call for all of
  the companies access programs
• Pfizer Helpful Answers
• Comprehensive program to expand access to
  prescription medications to uninsured
  Americans-single toll free number
• Pfizer Pfriends offers cost saving on most
  Pfizer medicines to patients of any age or income
  who dont have prescription insurance
• Expanded eligibility for free medicines Sharing
  the Care donates medicines to community, migrant
  and homeless health centers. Connection to Care
  provides access to medicines for low income
  patients via physicians

8
Evidence that healthcare workforce diversity may
reduce disparities

• Minority physicians more likely to practice in
  minority communities
• Minority physicians more likely to treat lower
  SES patients
• Patient-physician concordance associated with
  higher patient satisfaction, patient
  participation in care, and adherence
• Language concordance increases patient
  satisfaction, decision-making and self reported
  health status
• Diversity of workforce may improve its
  functioning

Sources Powe and Cooper. Diversifying the Racial
and Ethnic Composition of the Workforce Annals
of Internal Medicine 2004141(3)223-224.
Cooper-Patrick et al. Race, gender, and
partnership in the patient-physician
relationship. 1999 JAMA 282(6)583-589.
9
Evidence that Cultural Competence Training
reduces disparities

• AHRQ Evidence Report
• Cultural competence training increases health
  care providers knowledge (excellent evidence)
• Cultural competence training can improve
  attitudes and skills of healthcare providers
  (good evidence)
• Poor evidence that cultural competence training
  can improve adherence or health outcomes
• Provider knowledge, attitude, communication skill
  may improve patient satisfaction and adherence
• Insufficient evidence about which types of
  training (lecture, workshop, small group,
  cultural immersion) are most effective

Sources AHRQ Evidence Report 90, Beach, Price,
Gary, et al . Cultural competence A Systematic
Review of Health Care Provider Education
Interventions. Med Care 2005(3) 356-373.
10
Workforce Diversity and Cultural Competency

• Pfizer Minority Medical School Scholarships
• Established 1984
• Tuition scholarships awarded to 8 students per
  year at 4 historically black US Medical schools
• Charles R. Drew University of Medicine and
  Science in Los Angeles, Howard University College
  of Medicine in Washington, DC. Meharry Medical
  College in Nashville and Morehouse School of
  Medicine in Atlanta
• Pfizer Fellowship in Health Disparities-2006
• Supports career development of talented junior
  researchers
• Postdoctoral fellowship support for 2 years, for
  scientific research in health disparities
• Selected by independent academic advisory board

11
Health Literacy

• Partnership for Clear Health Communication
• Coalition of 19 national organizations, including
  Pfizer
• Promotes awareness and solutions around low
  health literacy
• Offers free and low cost resources and programs
  for medical education, practice management and
  patient communication
• Ask Me 3-tool to promote communications between
  patients and providers

12
Evidence that community interventions reduce
disparities RAND Report

• Systematic review of the literature to describe
  community based interventions and conditions
  targeted by REACH program (Racial and Ethnic
  Approaches to Community Health)
• Community and lay health workers have a
  consistent positive impact
• Education can be effective, but has dependencies
  (e.g., class attendance)
• Success varies based on disease/treatment

Source RAND, Research activities to assist the
Centers for Disease Control Program, Racial and
Ethnic Approaches to Community Healthhttp//www.r
and.org/health/reach/
13
Patient Empowerment

• Pfizers Partnership with the NAACP
• 3-year, 1million partnership to improve health
  and wellness of African Americans
• Focus on health promotion, disease prevention,
  strong doctor-patient relationships and access to
  affordable quality health care
• Distributing Women Like You video, raising
  awareness of HIV/AIDS
• Partnered on prescription drug access card for
  seniors

14
Empowering Consumers -Community Outreach

• Mini-Medical Schools
• Educates local residents about health promotion,
  disease prevention, disease management
• Conducted via partnerships between medical
  schools, community organizations, government and
  business

15
Community Health Workers

• Amigos En Salud
• Latino focused healthcare initiative designed to
  reduce health disparities among Latinos with
  diabetes and cardiovascular disease
• Health promoters provide peer to peer health
  education and support
• Targets newly diagnosed patients with language
  and culturally appropriate information, behavior
  change strategies
• Developed by Pfizer Health Solutions in
  partnership with providers in Los Angeles, CA,
  Hudson County, NJ ,Hartford, CT and San Antonio,
  TX

16
Patient Navigators

• Patient Navigation in Cancer Care Guiding
  Patients to Quality Care Toolkit
• Partnership between Dr. Harold Freeman, founder,
  president and medical director of Ralph Lauren
  Center for Cancer Care and Prevention, Pfizer and
  the health care association of New York State
• Tool kit includes training materials to assist
  patient navigators in implementing the program,
  targets a variety of forms of cancer in array of
  health care facilities and communities

17
Effectiveness of healthcare quality improvement
initiatives for racial/ethnic minorities

• AHRQ Evidence Report
• Excellent evidence quality improvement strategies
  targeting health care providers of
  ethnic/minority patients improved quality of
  providers
• Good evidence for improved appropriateness of
  care
• Fair evidence for improving health service
  utilization, adherence, satisfaction, and health
  status

Sources AHRQ Evidence Report 90
18
Disease Management/Healthcare Quality Improvement

• Southern HIV/AIDS Prevention Initiative
• Pfizer Foundation funded innovative HIV/AIDs
  prevention programs serving women and
  multicultural communities with 3 million
• States targets Alabama, Florida, Georgia,
  Louisiana, Mississippi, North Carolina, South
  Carolina, Tennessee and Texas
• Annual conference to share best practices

19
Research Support

• Racial Differences in Cardiovascular Health
• Assessing Care of Vulnerable Elders (ACOVE)
• Investigator Training
• Patient Outreach and Education About Clinical
  Trials
• Should I Enter a Clinical Trial? A Patient
  Reference Guide for Adults With a Serious or Life
  Threatening Illness-

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Potential Initiatives for Business Support

• Increasing Public Awareness
• Improving Care Access
• Workforce Diversity and Cultural Competency
• Health Literacy
• Patient Empowerment
• Community Health Workers
• Disease Management/Health Care Quality
  Improvement
• Research Support

21
Business Support for Community Health
Disparities Initiatives
Lisa Egbuonu-Davis, MD, MPH, MBA Pfizer Scholar
in Residence Womens Research and Resource
Center Spelman College