Understanding Health Care Reform and MassHealth Communities of Color
The Massachusetts Health Disparities Council
Tom Dehner, Medicaid Director
April 27, 2009

Overview
■	Current MassHealth race & ethnicity data
■	Impact of HCR 
■	Efforts to increase race and ethnicity data collection 
■	Acute hospital pay for performance measures on disparities
■	Next Steps

Current Data on MassHealth Enrollment by Race Ethnicity, FY2008 
■	There are two pie charts illustrating the percentages of enrolled members categorized by race. The pie chart on the left includes the category “No Answer”, for people who did not identify, and the one on the right excludes “No Answer figures”. 
■	In a pie chart on includes “No Answer”: 39% were White not Hispanic; 34% had no answer; 14% were Hispanic; 9% were Black not Hispanic; and 3% were other.
■	In a pie chart on excludes “No Answer”: 60% were White not Hispanic; 22% were Hispanic; 13% were Black not Hispanic; and 5% were other.  

Race and Ethnicity Data Details
■	Data is primarily self-reported on application for coverage.
•	Data source is the MassHealth data warehouse.
■	“Other” Race/Ethnicity category adds Other, Native American, Alaskan American, and Asian/Pacific Islander together.
■	The “MassHealth and Health Reform Programs” includes enrollment in MassHealth, CommCare and the Health Safety Net.

Changes Over Time
■	From FY2004, before Health Reform, to FY 2008 for MassHealth enrollment only:
•	The “Other” category grew the most, led by 83% increase of Asian Americans.
•	Hispanic grew 47% 
•	Black grew 40% 
•	White grew 18%
■	From FY2004 to present, for all Health Care Reform programs, there has been significant growth in the “not answer” segment.

Efforts to Increase Race & Ethnicity Data Reporting
■	Systematic edits in the application process are being made to ensure that new members or members re-determining eligibility are reminded to provide race and ethnicity data.
■	MassHealth is working with the Common Client Index Project to develop strategies for race and ethnicity data sharing across EOHHS agencies that serve MassHealth members. 
■	Strategies to work with the provider community to increase race and ethnicity data collection are being considered.

Acute Hospital P4P Health Disparities Measurement
■	Structural measures account for organizational factors that affect healthcare disparities.
■	Clinical measures assess disparities by clinical quality indicators.
■	Disparities measures data collection began RY08.

Health Disparities Measure Development Process
■	Conduct Environmental Scan
•	Review National/State Health Disparities Initiatives
o	Review medical literature on factors contributing to disparities
o	Review literature on system factors and approaches to reducing disparities (ION, JCAHO, CMS, NCQA, NQF, Baldridge)
o	Review literature on cultural competence/CLAS measures to identify consensus on measure constructs and quality scoring models (Baldridge, NCQA, Medicare)
•	Consult with Stakeholder Industry Leaders
o	AHRQ Office Clinical Quality (National Health Disparities Report Methods)
o	Federal DHHS Office Minority health
o	National Quality Forum—Cultural Competence Measures Project
o	Boston Public Health Commission Hospital Disparities Workshop
o	MA Medicaid Policy Institute Disparities Roundtable
o	MA Commercial Payer Initiatives: BCBSMA, HPHC, Tufts, GIC
o	MassHealth Hospital Quality Advisory Committee (HQAC)

Health Disparities Measurement & Incentive Strategy 
■	For the phase-in approach strategy:
•	The RFA08 (Yr. 1) HD-1 Structural Measure is to reward hospitals to improve organizational factors that support patient care delivery to reduce racial/ethnic health disparities. 
•	The RFA09 (Yr. 2) HD-2 Clinical Measure is to reward hospitals to report data by race/ethnicity and reduce disparities in clinical quality measures. 
■	The performance measure strategies for:
•	RFA08 (Yr. 1) HD-1 Structural Measure are to require hospitals to implement a minimum set of CLAS standards regardless of patient R/E/L mix served, and CLAS Measure (CCOSA composite).
•	RFA09 (Yr. 2) HD-2 Clinical Quality Measures are maternity/newborn indicators, pediatric asthma indicators, pneumonia indicators, and surgical infxn prevention indicators. 
■	The performance assessment method strategy for: 
•	RFA08 (Yr. 1) HD-1 Structural Measure are CLAS validation rate, CLAS best practice rating, and CLAS measure score.
•	RFA09 (Yr. 2) HD-2 Clinical Measures are Data validation rate (RY09) and clinical disparity measure score (RY2010). 
■	The bonus payment approach strategy for:
•	RFA08 (Yr. 1) HD-1 Structural Measure is to earn payments for meeting performance thresholds on organizational factors (implementing CLAS).
•	RFA09 (Yr. 2) HD-2 Clinical Measures is to earn payments for meeting performance thresholds on clinical disparities measures. 
                                            
RY08 CLAS Measure Rate Results for Hospital Practices Implemented by Organizational Core Function.
■	The hospital measure rate for Governance Practices was 74% in RY07 Ave and 79% in RY08 Ave.
■	The hospital measure rate for Administrative/Management Practices was 73% in RY07 Ave and 79% in RY08 Ave.
■	The hospital measure rate for Service Practices was 82% for RY07 Ave and 86% for RY08 Ave. 
■	The hospital measure rate for Customer Relation Practices was 70% for RY07 Ave and 76% for RY08 Ave.
■	The hospital measure rate for the Total Measure Rate was 76% for RY07 Ave. and 81% for RY08 Ave. 

Next Steps 
■	Improved reporting of race and ethnicity data is essential.
■	MassHealth is committed to increasing the work with our provider and member communities to improve access and delivery of quality care.
■	Disparities measured by claims data versus survey data create different challenges.
Fee-For-Service Members
■	196,200 members receive Medicare with MassHealth Service Wrap.
■	68,800 members receive MassHealth FFS only, which excludes emergency services only population.
■	65,800 members receive Comprehensive Private Insurance with MassHealth Service Wrap, including Premium Assistance and ESI.
■	55,700 members receive MassHealth Emergency Services Only, which is limited.
■	1,100 members receive EAEDC.