Closing a gap in care quality

Health: Employers and insurance companies test ways to help minority workers get the most out of the system.

Medicine & Science

September 13, 2004|By Julie Bell | Julie Bell,SUN STAFF

Every night, an insurance-company computer compiles a list of certain Marriott International Inc. employees in Miami and Houston who have received a new prescription for hypertension or diabetes medication.

Each morning, the information shows up on a spreadsheet in front of two Aetna nurses in Middleton, Conn., who phone the employees at home.

"Have you been to a doctor recently?" they ask, in Spanish or English. "Do you have any questions ... regarding your recent visit with your doctor?"

The pilot project is aimed at ensuring that Marriott's numerous Hispanic employees understand their health benefits -- and use them. It's one example of how large employers are beginning to work with insurers to close the well-documented gap between the health of minorities and that of whites.

Quality issue

A 2002 report from the Institute of Medicine, a nonprofit government advisory arm of the National Academy of Sciences, detailed the problem. It noted that minorities tend to receive lower-quality health care than non-minorities, even when both have similar health insurance and income.

A number of government-sponsored initiatives have followed, including last year's legislation requiring Maryland health officials to develop a plan to reduce disparities based on race, gender, ethnicity and poverty.

This summer, the University of Maryland School of Medicine established its own Center for Health Disparities, aimed at promoting health care in urban and rural communities with concentrations of racial minorities and low-income whites.

But the efforts of private employers and insurers have received less attention. Universally, they're spurred by the assumption that productivity will rise and health-care costs for all will be lower if minority employees are healthier -- though there are no hard data yet to prove it.

Verizon Communications, for example, recently began grading insurers that cover its employees on how they address health disparities. Kaiser Permanente, the giant insurance and health care provider, gives its physicians pocket cards containing tips designed to make minorities feel more at home. An example: "Many Asians and Pacific Islanders are uncomfortable with casual touching or hugging."

This year, Kaiser also began a program in the mid-Atlantic region to certify employees who speak multiple languages so that they can translate for patients and doctors.

CareFirst BlueCross BlueShield is likewise developing programs aimed at burgeoning minority populations, said Rita Costello, a senior vice president for the insurer that operates in Maryland, Northern Virginia, Delaware and Washington, D.C.

"The fastest-growing populations are more diverse, Hispanics and Asians particularly," Costello said. "That has major implications on us, since we are the largest carrier in the region: What about their special needs? What kinds of products, what kinds of languages do we need to know?"

Nationally, the U.S. Census Bureau estimates that Hispanic and Asian populations will triple over the next half-century, while the proportion of non-Hispanic whites will fall from 69 percent of the population today to about 50 percent in 2050.

That has implications for the nation's health, according to the first National Healthcare Disparities report, released last year, released this year by the Health and Human Services Department.

That report found, for example, that minorities are more likely to be diagnosed with late-stage breast cancer and colorectal cancer than whites, indicating a lack of screening that could have caught the diseases early. Other studies have found that hypertension and diabetes are more prevalent in African-Americans than in whites.

Sensitive matters

But employers' efforts to respond are complicated by concerns that minority employees might feel they're being unfairly singled out. At a recent daylong conference on the subject in Baltimore, some employers and insurers wondered how they could target employees for health disparities programs without running afoul of federal privacy rules or offending workers.

"This is a sensitive political issue," Dr. Michael C. Tooke, chief medical officer of nonprofit quality consultant Delmarva Foundation, told the gathering. "We have to get together and say, we're going to collect this data and it's OK."

Dr. Annelle B. Primm, director of minority and national affairs at the American Psychiatric Association and a Johns Hopkins University faculty member, said it would be far worse to take no action.

"People are disabled by this," she said. "People are dying."

The issue of health disparities is already an enormous one for Marriott: About 40 percent of its employees don't speak English as their primary language, said Karen G. Graham, Marriott's health plan manager.

The company spends about $350 million annually on health benefits for the 91,000 employees eligible for them. It uses 67 HMOs and one traditional insurer to provide the coverage.

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