CA Black Health Network · CA Black Health Network “Paradigm Shift: Health Care Delivery and Access, Healing Our Families and Strengthening Our Village” January 8, 2014 – 10AM

CA Black Health Network “Paradigm Shift: Health Care Delivery and Access,

Healing Our Families and Strengthening Our Village”

January 8, 2014 – 10AM to Noon (PST) Building healthy communities now and for the future.

Introduction of Presenters

Wenonah Valentine, MBA African American Series Webinar Facilitator Founder and Executive Director iDREAM for Racial Health Equity

B. Darcel Lee President and CEO, California Black Health Network

Michael E. Harris, MS

Senior Fellow, University of Southern California Sol Price School of Public Policy Health Care Consultant and Speaker

Wenonah Valentine, MBA Facilitator

Healing Our Families: A Snapshot of Health Disparities

What Are Health Disparities?

Health disparities are gaps in the quality of health and health care that mirror differences in socioeconomic status, racial and ethnic background, and education levels

These disparities may stem from many factors, including

• accessibility of health care • increased risk of disease from occupational exposure • increased risk of disease from underlying genetic, ethnic, or

families

Source: National Center for Biotechnology Information, U.S. National Library of Medicine 8600 Rockville Pike, Bethesda MD, 20894 USA

Source: California Newsreel, 2008

http://www.ncbi.nlm.nih.gov/

http://www.nlm.nih.gov/

http://www.nlm.nih.gov/

Unique Focus on Mental Health

• The death rate from suicide for African American men was almost four times that for African American women (Based on most recent 2009 data)

Building healthy communities now and for the future.

•A report from the U.S. Surgeon General found that from 1980 - 1995, the suicide rate among African Americans ages 10 to 14 increased 233%, as compared to 120% of Non-Hispanic Whites.

Source: 2011 National Healthcare Disparities Report

Life Expectancy

• Life expectancy longer for women than men – 84.3 years for women – 79.1 years for men

• 9 years difference in life expectancy between API women and black women

87.9

79.1

85.3 83.8

74

76

78

80

82

84

86

88

90

API Black Latina WhiteYe

ars

Life Expectancy among Women by Race/Ethnicity

2009 CA DPH Death Statistical Master File and 2009 Population Estimates, OHAE, DPH 6

Unique Focus on Mental Health

Poverty level affects mental health status. African Americans living below the poverty level are 3 times more likely to report psychological distress.


African Americans are 20% more likely to report having serious psychological distress than Non-Hispanic Whites.

Non-Hispanic Whites are more than twice as likely to receive antidepressant prescription treatments as are Non-Hispanic Blacks

Source: 2011 National Healthcare Disparities Report

Determinants of Health Among Women in Los Angeles County by Race/Ethnicity, 2011

13 8

15

24

11

17

25

42

49

17 22

34

5 8

11

23

0

10

20

30

40

50

Less than high school education Unemployed (and looking forwork)

Late or unable to payrent/mortgage in past 2 years

Food insecure

Perc

ent o

f Wom

en

Asian/Pacific Islander Black Latina White

2011 Los Angeles County Health Survey 8

Health Conditions • At Risk for Heart Disease (≥ 2 out of 6 risk factors)

– 30% of women; 45% of black women • Obesity

– Increased from 15% in 1997 to 24% of women in 2011 – 36% of black women and 33% of Latinas

• Ever Diagnosed with Diabetes – Increased from 6% in 1997 to 9% of women in 2011 – 12% of black women, 10% Latinas and API women

• Current Depression – 10% women, 6% men – 15% white women, 14% black women – 51% of women with live birth – postpartum depressive symptoms (2010 LAMB

Survey)

2011 Los Angeles County Health Survey 9

Access to Mental Health Care Services

Basic health and mental health care disparities are highly associated with access in general and lack of insurance


African Americans living in poor neighborhoods or human service deserts are overrepresented by poor access to healthcare and quality of care. Disparities may also occur at the provider level, with racial and ethnic groups overrepresented in practices providing low-quality care New concepts in providing care such as Triple Aim, Evidence Based Medicine lags in being implemented in the Black and racial/ethnic communities

1. Identify historical factors impacting the Black Community and their access to health care including mental health care services 2. Discuss access to health care services and health disparities 3. Discuss how populations have responded to limited access to health care services 4. Highlight the impact of the Affordable Care Act (ACA) on basic and mental health services

Key Presentation Objectives

B. Darcel Lee President and CEO

California Black Health Network

CA Black Health Network: Our History

• Founded in San Diego, CA in 1978 • Founded by small group of health professionals • Founded to create a voice for African American health

concerns in the state of California • Founded to address the issues of disparities within the health

care system • Established chapters throughout the state focused on

addressing chronic disease issues in AA communities • Evolved into a policy & advocacy organization with offices

only in Sacramento

CBHN Mission & Vision

• CBHN Mission • To improve the health status of people of African American

descent in California and eliminate health disparities through legislative, administrative and media advocacy.

• CBHN Vision • To see healthy families in healthy communities throughout the

state

CBHN Core Values

• Accountable We practice financial fitness ensuring stability, consistency and sustainability

• Relevant We are contemporary in our approach to issues, ensuring our work is current, innovative when necessary, and steeped in community-based need.

• Integrity We say what we do and we do what we say with a steadfast adherence to principles.

• Collaborative We embrace strategic alliances, align and integrate our work with others with shared vision and values.

• Inclusive We incorporate diverse perspective into our work. We consider our social responsibility and we make informed decisions that are impactful

Advocates for African American Communities

• Links, Inc. San Francisco

• Alere, Inc.

• Individuals in churches organizations and/or agencies

• iDREAM for Racial Health Equity

State Legislature

Regulators

Department of Health

Covered California

CBHN

Government

Community

Corporate

Individuals

CBHN Covered California Collaborative

San Diego Black Health Associates San Diego County The G.R.E.E.N. Foundation Orange County Black Women for Wellness Los Angeles County Great Beginnings for Black Babies Los Angeles County Bay Area Black United Fund Alameda County

Health & Human Resource Education Center Alameda County Center of Praise Sacramento County Center for Community Health & Well Being Sacramento County Images Production Co. Sacramento County Sac Cultural Hub San Joaquin and Sacramento County

CBHN Collaborates on Black Infant Health

CBHN Formed Collaborative to address Black Infant Health in Sacramento County & won a First 5 Grant for $750,000

Collaboration includes: • The Birthing Project USA

• Center of Praise • 6 other Sacramento County Churches

• Former SisterFriends

Inspired by the CBHN Black Infant Health Statewide Alliance

CBHN Policy Agenda


Prevention & Wellness

HealthCare Reform

Black Infant Health

Boys & Men of Color

Mental Wellness

Environmental Health

Mental Wellness: Foundation for Health & Well Being

1. African Americans live with untreated depression and other mental illnesses at higher rates than whites.

2. Driving this disparity - more frequent psychiatric crises due to unmanaged episodes of depression, schizophrenia, and other mental illnesses.

3. Acute alcohol and drug related disorders also lead to more frequent ER visits.

Source: Ethnic Health Assessment for African Americans in California; www.CABlackHealthNetwork.org

B. Darcel Lee President and CEO California Health Network, Inc.

Contact Information Headquarters: New Address: 509 9th Street, Suite 209 Sacramento, CA 95814 Telephone: 1-916-333-0613 Email: [email protected]

Michael E. Harris Senior Fellow

University of Southern California

Foundation and Data

Background and Perspective

Demographics In 2011 African Americans including those of more than one race was estimated at 43.9 million, making up 13.6% of the total U.S. population African Americans made up 12.8% of the U.S. population-over 39 million people By the year 2060, there will be 77.4 million African Americans in the United States, making up 18.4% of the total U.S. population Access to health care and elimination of health disparities must be a focused agenda if we are to improve health care

Source: US Census

Diminished Access to Health Care Leads to Poor Outcomes

Insurance Status and Source of Care

African Americans

Non-Hispanic Whites

Uninsured rate 21% - 24% 11%

No usual source of care (e.g., Primary Care Physicians)

24% 18%

Office-based care 57% 73%

Hospital-based care 18% 8%

Hospital based Emergency Rooms

1% 0.4%

Source: CDC and Kaiser Foundation

Being uninsured and providers unwilling to accept their insurance

Accessing care at emergency rooms and free or low-income clinics

Worry and are concerned about access to healthcare

Being turned away from healthcare due to cost and other factors

Lack of provider continuity and rapid turnover

Health Care Disparities: Contributing Factors

Patient Education and

Patient Health Prioritization

Health Care Delivery Structure

Providers & Community Based

Services

Lack of Insurance and

Financing

Cultural and

Linguistic Factors

Health Disparities Contributing Factors

Source: Journal of General Internal Medicine, July 2002

Other Key Factors: Income

Failed structural

design to address patient needs

Failed use of population data to build a sustainable model

Lack of collaboration among payers and providers

Contributing Factors

• Health Care Delivery Structure • Understanding the services needed and the optimal delivery

model • Developing health care frameworks to efficiently deliver the

appropriate health care services to sin need

• Cultural and Linguistic Factors • Understanding the cultural and linguistic barriers to ensure

that patients are heard, understood and treated appropriately • Improving the overall communication between providers and

patients and their family

Contributing Factors

• Health Insurance and Financing • Redefining the health care delivery cost structure to ensure that

providers will delivery the necessary patient care

• Provider Network Services • Continue to recruit and build a provider network who have a passion

for healing

• Patient Education and Prioritization • Re-defining how to education patient to become partners in their

recovery and wellness journey • Changing their health and wellness habits

Compelling Clinical Challenges

Health Care Scorecard: The Facts A Call to Action

• Status and Concerns 16% of Black Americans report their health status as “Fair to Poor”

20-24% of Black Americans lack access to “usual and basic” health

care; Basic and usual is defined as access to primary care services Black Americans are twice as likely to rely on hospitals and clinics for

their “usual and basic” care. Typically, seeking episodic care using the Emergency Room as their primary source of health care, versus accessing preventive and maintenance care

Source: CDC Health Disparities & Inequalities Report - United States, 2011



Critical Disparities (Cont’d)

• HIV infection rate among African Americans in 2008 was the largest rate compared with those of other racial and ethnic populations. African Americans represented 49% of the new HIV cases in 2011, an increase of 5% from 2010.

• This trending is continuing…

Source: National Institute of Allergy and Infectious Diseases, January 2013;

The Kaiser Family Foundation, March 2013


Building healthy communities now and the future.

Clinical Manifestations for African Americans

• 50% less likely to get heart bypass surgery

• 25% less likely to get pain medication

• 54% as likely to get colon cancer screening procedures

• 34-35% of patients lymphoma are likely to undergo a bone marrow transplant

• 12.7% less likely to get surgery for lung cancer Source: Agency for Healthcare Research and Quality, April 2013

Mental Health Status

Frequent Disparity Challenges

Black Americans feel they are misunderstood and treated with disrespect

Frequent Disparity Challenges

Difficulties communicating with physicians and other clinical providers

Mental Health Scorecard

• Culture biases against mental health professionals and health care professionals in general prevent many African Americans from accessing care due to prior experiences with historical misdiagnoses, inadequate treatment and a lack of cultural understanding

• Only 2 percent of psychiatrists, 2 percent of psychologists and 4 percent of social workers in the United States are African Americans

• African Americans tend to rely on family, religious and social communities for

emotional support rather than turning to health care professionals, even though this may at times be necessary. The health care providers they seek may not be aware of this important aspect of person life.

Mental Health Care Delivery Services

• Disparities in the workforce may account for additional disparities in mental health than general health care

• Also, disparities in mental health professionals are likely to contribute to the inadequate representation of minorities in research, including in important clinical trials


Barriers to Mental Health Services


Barriers to mental health care include

Cost of care Limited or no mental benefits Societal and cultural stigmas that still associated with mental

health especially in the Black Community Access to mental health professionals who understand the

cultural differences associated with African Americans Fragmented organization and coordination of services with

primary care providers Patient’s fear and mistrust of treatment and providers

Michael E. Harris, Senior Fellow University of Southern California

Contact Information

Telephone: 1-310-316-2900 Email: [email protected]

Wenonah Valentine, MBA Presenters Dialogue:

Strengthening Our Village: A collaborative response to

African American mental health issues

Paradigm Shift : Healthcare Delivery & Access

The Right Thing At the Right Time In the Right Way

With the Right Results

Presenters Dialogue Topic# 1: Improving Health Care in the Black Community

Strengthen the stability of patient-provider relationships in publicly funded health plans


QUESTION: Using our knowledge as a bridge, how do we encourage a shift in thinking towards patient & provider as health partners?

Presenters Dialogue Topic #2: Improving Health Care in the Black Community

Social investment in African American communities is a bigger conversation than access issues. Human services deserts adversely affect the social and psychological well-being of African American residents. QUESTION: How do we achieve health equity in our poorest, inner city neighborhoods?


Presenters Dialogue Topic #3: Health Care Delivery System

• Promote the consistency and equity of care through the use of evidence-based guidelines

QUESTION: Give examples of new concepts in evidence-based medicine that would benefit African American communities.


Presenters Dialogue Topic #4: Patient Education – Managing Our Message

HOW DO YOU RESPOND TO:

“Congregations are a poor substitute for nonprofit human services.” Source: 2013 State of the Nonprofit Sector in Los Angeles Report, UCLA Luskin School of Public Affairs

“... take non-traditional health and diseases prevention messages into the backbone of African American communities: churches, schools and even, barbershops.” Source: Race Matters in Healthcare. Black Issues in Higher Education, May 23, 2002


Presenters Dialogue: Topic #5 Equipping a Pipeline of Health Leaders

Integrate cross-cultural education into the training of all current and future health professionals. Make the case for training a new generation of diverse and culturally-competent healthcare leaders and community health advocates.

Source: iDREAM Digital Archives

Collaborative Partner

Contact Information

CALIFORNIA INSTITUTE FOR MENTAL HEALTH Website: www.CiMH.org

Telephone: 1-916-379-5328

“Helping Health Professionals Improve the Lives of People with Mental Health and Substance Use Challenges”

http://www.cimh.org/

Collaborative Partner

Wenonah Valentine, MBA, CBHN Consultant

[email protected]

Telephone: (213) 458-9706

www.idreamnow.org Launch updates mid-January 2014

A leadership, training and development network dedicated to equipping a pipeline of change agents and addressing the complex health issues unique to African American mothers and babies throughout the life course. iDREAM for Racial Health Equity is a project of Community Partners®.

mailto:[email protected]

http://www.idreamnow.org/

Thank You for Your Participation


Connect with CBHN www.cablackhealthnetwork.org

Telephone 916-333-0613

http://www.cablackhealthnetwork.org/

Bonus Reference Materials

Note: These additional reference materials are provided for your future use and may not be discussed during the webinar.


• Eliminate fragmentation of health plans along socioeconomic lines

• Strengthen the stability of patient-provider relationships in

publicly funded health plans

• Increase U.S. racial and ethnic minorities among health professionals

• Apply the same managed care protections to publicly funded HMO enrollees that apply to private HMO enrollees

• Provide greater resources to the U.S. DHHS Office of Civil Rights to enforce civil rights laws



• Community wide education: collaborative focus of payers, employers and patients in the community to support health benefits. Population management

• Creating “grass roots” cultural change in this

county and among the black community to focus and be champions of their individual health; starting with our children – the next generation.


Presenter Dialogue Topic #3: Health Care Delivery System

• Promote the consistency and equity of care through the use of evidence-based guidelines;

• Structure payment systems to ensure an adequate

supply of services to minority patients, and limit provider incentives that may promote disparities

• Provide incentives for practices that barriers and

encourage evidence-based practice


Presenters Dialogue Topic #4 & #5: Patient Education

• Patient education programs – To increase patients’ knowledge of how to best

access care - Increase patient and family engagement and participation in treatment decisions

• Integrate cross-cultural education into the

training of all current and future health professionals.


Next Steps: Big Data and Population Health

• Collect and report data on health care access and utilization by patients’ – race – ethnicity – socioeconomic status

Include measures of racial and ethnic disparities in performance measurement

• Monitor progress toward the elimination of health care

disparities


Next Steps: Research Leading to Change

• Conduct further research to – Identify sources of racial and ethnic

disparities – Assess promising intervention strategies

• Conduct research on barriers to eliminate

disparities


Affordable Care Act

The Affordable Care Act (ACA) has begun to highlight the current health disparities in very meaningful ways:

Providing health insurance for all US Citizens

Creating a structural framework to increase access to health care

Establishing quality metrics for health care standards

Building a sustainable business model for health care

Increasing providers to provide care

Leading the charge for greater transparency in health care

Increasing innovation to improve health care delivery and efficiency

Affordable Care Act

• The Affordable Care Act (ACA) attempts to address the health disparities while also attempting to address other concerns related to the delivery of health care services in the United States

• African American adults aged 18-64 years had substantially larger percentages of uninsured populations

• I in 6 uninsured in this the US are African Americans

• There is an estimated 6.8 million uninsured African Americans in

the U.S. Source: American Community Public Use Microdata

Affordable Care Act and Mental Health


• ACA also builds on the Mental Health Parity and Addition Equity Act of 2008

• Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 million Americans

• The focus is to ensure that when mental health coverage is offered, it is comparable to coverage for medical and surgical care Source: ACA, 2010

Health Care Scorecard: Delivery in the Black Community

An analysis of 1.7 million hospitalizations, reveals that black women had a significantly lower rate of therapeutic procedures than white women for nearly all female reproductive system diseases. In general, blacks had a significantly lower rate of

therapeutic procedures than whites for several common cancers such as colon, bladder, cervical, and breast cancer

Source: Receipt of certain major procedures by hospitalized adults varies by race and sex. Harris, Andrews, and Elixhauser, Ethnicity and Disease 7, pp. 91-105, 1997.

Health Care Scorecard: Delivery in the Black Community


• Among many sex-age groups, the prevalence of obesity from 2005-2008 was lower among White Americans than among African Americans or Mexican Americans. Among females aged 20-39 years, the prevalence of obesity was largest among African Americans

• Infants of African American women in 2006 had death rates twice as large as infants of White American women

• This trending is continuing… Source: CDC Health Disparities & Inequalities Report - United States, 2011

Access to Mental Health Care Services

• Health and mental health care may differ in the impact of providers on disparities. Specifically, physicians tend to hold a prior belief about the likelihood of a patient having a condition and update this belief according to the strength of information received in the clinical encounter;

• African Americans tend to have a more substantial challenge communicating with health care providers

• Low treatment rates in Black communities are likely related to poor minority representation in the health care workforce


References

1. CDC Health Disparities & Inequalities Report - United States, 2011

2. Covered California; www.CoveredCA.com; 1-800-300-1506

3. Affordable Care Act

4. Agency for Healthcare Research and Quality, April 2013

5. National Institute of Allergy and Infectious Diseases, January 2013

6. Medical Expenditure Panel Survey Data

7. Measuring patients’ perceptions of communication with healthcare providers: Do differences in demographic and socioeconomic characteristics matter?

8. Race Matters in HealthCare. Black Issues in Higher Education, May 23, 2002

9. State of the Nonprofit Sector in Los Angeles Report- UCLA Luskin School of Public Affairs, 2013

10. Unnatural Causes: Is Inequality Making Us Sick? – California Newsreel, 2008

11. Health Indicators for Women in Los Angeles County – County of Los Angeles Public Health, 2013

http://www.coveredca.com/

Documents

CA Black Health Network · CA Black Health Network “Paradigm Shift: Health Care Delivery and Access, Healing Our Families and Strengthening Our Village” January 8, 2014 – 10AM