Reducing Disparities: Ideas for States

$337 billion. That’s how much higher rates of chronic disease among Africans Americans and Hispanics relative to non-Hispanic whites will cost the country over the ten-year period from 2009-2018, according to a 2009 Urban Institute report. These dollar costs arise from disturbing human costs. According to national survey data, the risk of diagnosed diabetes is 77% higher among non-Hispanic black adults than among non-Hispanic white adults. Hispanic/Latino adults are at a 66% greater risk than non-Hispanic whites. It’s easy to find other troubling statistics that show significantly higher rates of morbidity and mortality among racial and ethnic minorities than among whites.
Across the country, states are working to address these problems. With the support of the Aetna Foundation, NASHP is launching a project to help states promote health equity through health reform implementation. I recently tuned in to a webcast facilitated by Diane Justice, Senior Program Director at NASHP, to learn more about options for states (the webcast slides are available online, as is a complete recording). Here are four high-level takeaways from the webcast that can help jumpstart or strengthen state efforts to advance health equity:

• Learn about health equity in your state. Before launching efforts to increase equity, it helps to know where your state stands. The Agency for Healthcare Research and Quality (AHRQ) has developed some outstanding free tools that can help officials and stakeholders see how their states are doing in this area – both in absolute terms and relative to other states. On AHRQ’s website, the state snapshots section on disparities provides simple overviews of state health equity performance. The tool includes information on ambulatory care and hospital care across four racial/ethnic groups. (See the graphic at right for an example.) This kind of information can help officials identify priority areas, target resources, and make the case for change in their states.
• Consider health reform opportunities. The Affordable Care Act (ACA) contains a variety of provisions that can support state efforts to promote health equity. During the webcast,Dennis Andrulis of the Texas Health Institute discussed a number of ACA provisions and their relevance to health equity, including:
  • Requirements for cultural and linguistic competencies in the operations of State Health Insurance Exchanges
  • Adoption of tested outreach, enrollment, and retention strategies to maximize participation of newly eligible racial and ethnic minorities in Medicaid
  • Availability of over $100 million in Community Transformation Grants, funding to reduce chronic disease and promote health equity

• Apply to join a new state learning community. NASHP’s new State Health Equity Learning Collaborative will provide assistance to seven states working to advance health equity through health care reform implementation.   The Collaborative, funded by the Aetna Foundation, will offer access to expert consultation, implementation resources, and networking with out-of-state peers. Teams of Medicaid, public health, and minority health officials are encouraged to apply. Responses to the request for applications (RFA) are due no later than August 23. A prospective applicant call will be held on August 9.
• Consult existing resources and stay tuned for more. AHRQ’s Healthcare Cost and Utilization Project (HCUP) has published several reports and issue briefs on state action to reduce racial and ethnic disparities, while The Commonwealth Fund maintains a portion of its website devoted to racial and ethnic health disparities. The Synthesis Project, an initiative of the Robert Wood Johnson Foundation, has summarized the literature on racial and ethnic disparities in access to and quality of care. Officials and stakeholders may also wish to look at state documents on disparities. For example, read about how Maryland plans to reduce racial and ethnic disparities through health reform implementation (see page 26 of the report).

Looking for a place to share resources with your peers or ask questions? State Refor(u)m includes a milestone devoted to health equity: have a plan for advancing health equity that addresses racial, cultural, ethnic, socioeconomic and geographic disparities. State users and national experts are already discussing disparities and sharing resources on the national milestone page. What is your state doing to address disparities? Join the conversation by posting on your state-specific milestone page.