Minnesota is one of the healthiest states in the nation. On a variety of indicators, from insurance status to life expectancy to the overall quality of health care, Minnesota ranks at or near the top among all states. But Minnesota also has some of the largest inequities in health status and incidence of chronic disease between populations. According to the Institute of Medicine, communities of color are less likely to receive preventive care; more likely to suffer from serious illnesses and have less desirable health outcomes; and less likely to receive clinically-necessary procedures and services.
These inequities are both morally unacceptable and pose a threat to the health and economic stability of all Minnesotans. But a significant obstacle to eliminating health disparities has been the relative lack and inconsistent collection of data, both locally and nationally. In order to effectively address inequities in health care on a large scale, we need consistent, actionable data that provides a window into where disparities exist, their underlying causes and how to address them.
Throughout our ten-year history, MN Community Measurement (MNCM) has worked hard to provide that window through the collection of race, Hispanic ethnicity, preferred language, and country of origin data; and publication of reports that evaluate disparities based on those demographics as well as socioeconomic status.
Pioneering REL Data Collection
In 2008, MNCM set out to identify a common set of data elements that, if collected in a standardized way and married with clinical results, could aid in the evaluation of health inequities in Minnesota. We were in a unique position to collect and validate race, Hispanic ethnicity, preferred language and country of origin (REL) data as a result of our existing Direct Data Submission (DDS) process that was already being used by medical groups to submit data for quality measures.
In 2009, we collaboratively with a variety of community members to produce the Handbook on the Collection of Race/Ethnicity/Language Data in Medical Groups, which established a standard set of data elements and best practices for medical groups to collect REL data from patients. The effort was focused on medical groups and clinics participating in our DDS process with the goal of eventually reporting the results and allowing comparison across organizations and regions.
The following year, we asked medical groups to voluntarily submit REL data with their quality measure data; one year later, we required it. As medical groups were getting accustomed to collecting and reporting this data, MNCM’s Measurement and Reporting Committee approved public reporting of the results once 60 percent of providers were do so using the best practices outlined in the Handbook.
It would take three years for our community to reach that milestone. Minnesota providers steadily improved their collection and reporting of REL data. As they surmounted technical, process and organizational barriers, the percentage of groups reporting data using best practices gradually increased. The work was undertaken at a deliberate, gradual pace that built trust in the process and credibility in the data.
By early 2013, a large enough proportion of medical groups were using best practices to collect and report REL data that we were able to produce private medical group reports for those groups. These allowed them to see optimal care results stratified by REL for their own group. This objective, repeatable data allows groups to reflect on inequities in their own patient population and identify areas for improvement.
And in 2014, we accomplished the goal we were working so hard to achieve: more than 85 percent of providers in Minnesota collected and reported REL data in some way; and about 70 percent were verified as using best practices and, as a result, could be publicly reported. We expect an even higher percentage in both categories this year.
Reporting Health Disparities: Race, Ethnicity, Language and Country of Origin
At the beginning of 2015, MNCM released our inaugural Health Equity of Care Report: Stratification of Health Care Performance Results in Minnesota by Race, Hispanic Ethnicity, Preferred Language and Country of Origin. It features statewide and regional results on health care outcomes in five areas (Optimal Diabetes Care; Optimal Vascular Care; Optimal Asthma Care for Adults; Optimal Asthma Care for Children; and Colorectal Cancer Screening) stratified by race, Hispanic ethnicity, preferred language and country of origin.
As the first report based on data collected from patients by medical groups, its release marked the first comprehensive look at health disparities in Minnesota. It also tells a compelling story: it not only supports other findings that significant racial and ethnic health care disparities exist, but went a step further to pinpoint the results by region of Minnesota. To reduce and eliminate health inequity, we must understand where it exists and its scope, so we can target effectively. Identification and increased awareness of disparities is a critical first step toward closing the gaps.
This information will help medical groups, policy makers, advocates and community leader’s better target efforts to reduce and eliminate health inequities in our state. It will help focus and evaluate population health improvement opportunities, as well as drive public policy and resource allocation to the geographic areas and populations most in need.
Reporting Health Disparities: Socioeconomic
Beginning in 2007, MNCM has partnered with the Minnesota Department of Human Services to produce the Health Care Disparities Report for Minnesota Health Care Programs. It evaluates health care disparities based on socioeconomic status by comparing care received by patients insured through Minnesota Health Care Programs (MHCP) and those covered by other payers. Additionally, for the past four years, it has included some statewide race and ethnicity information for MHCP patients.
Before the release of the first report, national and state reports of health inequities in Minnesota were dismissed as being the result of patient factors and issues outside medical groups’ control, or because of the perception that gaps in care might exist elsewhere but not in their own medical groups. The medical group-level reporting in the Health Care Disparities Report makes it impossible to ignore.
Minnesota patients enrolled in MHCP have seen improved health outcomes in most areas since the first report was issued. These improvements are due, in part, to increased transparency of these outcomes, which results in more accountability at all levels of health care. And some of them are dramatic; for example:
- 32 percent increase in Optimal Asthma Care for Children over four years;
- 25 percent increase in Optimal Asthma Care for Adults over four years;
- 23 percent increase in Childhood Immunizations over nine years; and,
- 15 percent increase in Appropriate Testing for Children with Sore Throats over nine years.
Continuing to Shine a Light on Inequity
Our state and country benefits when everyone has the opportunity to live healthy, productive lives. Eliminating health care disparities will create a more equitable and productive society for all of us. Data alone will not achieve health equity goals; however, it’s a critical element to our ability to identify and implement solutions that will.
“There is considerable and critical work to be done to eliminate health care disparities in Minnesota,” said MNCM President Jim Chase. Minnesota is unique, he added, in that so many medical groups around the state “are collecting this type of information and trying to use it for improvement.”
“Patients shouldn’t be surprised now if they are asked much more frequently what their race or ethnicity is,” he added. “What we’re hoping is that patients will actually welcome that question because they realize their provider is asking it to find ways to give them better care.”
Our community can focus on identifying and implementing solutions, knowing the results will be evaluated annually by MNCM to guide future work and priorities. It’s those improvement strategies that will ultimately result in the reduction of disparities and the elimination of health inequities in Minnesota and our nation.