Sixth National Conference on Quality Health Care for Culturally Diverse Populations: Poster Presentations Perspectives on Integrating Cultural Competence into Pay-for-Performance
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Poster Session I Poster Presentations (Group I)

Perspectives on Integrating Cultural Competence into Pay-for-Performance
Monday, September 22, 2008: 1:00 PM-7:30 PM, Minn Marriott, 4th Floor - Atrium
Poster Title: Incorporating Cultural Competence into Pay-for-Performance

Abstract:
California’s quality improvement (QI) efforts have accelerated with the initiation of the state’s Pay for Performance program (P4P), which offers financial rewards and recognition for medical groups that demonstrate excellence in clinical care and patient experience. In a state known for its diversity, and thus disproportionately affected by disparities in quality of care, there has been little conversation about the relevance of incorporating cultural competence into QI efforts for commercially insured populations. Recent research has demonstrated the potential value of continuous quality improvement in reducing health disparities and improving cultural competence. There is also growing national interest in cultural competence and health disparities among employers and insurers.

We conducted an exploratory study in partnership with Integrated Healthcare Association and Pacific Business Group on Health who respectively oversee the state P4P program and provide education and training to medical practices in order to improve performance on measures. Using convenience sampling methods we interviewed leaders representing medical groups, independent practice associations, and health plans. Our findings include descriptive summaries of whether organizations collect race, ethnicity or preferred language data and qualitative analysis of structured interviews. The qualitative findings summarize perspectives on necessity of collecting race, ethnicity and preferred language data, characteristics of patient populations who are challenging to practices from QI and P4P perspectives and what groups are currently doing to tailor disease management programs to meet the needs of populations. We also report on interviewees reactions to the including cultural competence measures in P4P, the types of measure to use and whether such inclusion should focus on rewards or recognitions. We conclude with a discussion of the implications of our findings for state and national organizations that are contemplating incentives to reduce health care disparities and a discussion of next steps for California’s program.

Presentation Information:

Program: Poster Presentations
Primary Category: Culturally Competent Care
Subtopics: Observational/descriptive studies, Organizational plans, policies, management strategies, Data collection (on individuals and communities), Quality improvement

Region Addressed by Presentation: US - California
Organization: Managed Care Network
Population/Demographic: NA
Keywords: Pay for Performance, Quality improvement, Independent practice organizations, medical groups
Sunita Mutha, MD , Center for the Health Professions, UCSF, San Francisco, CA
    Associate Professor of Medicine
    UCSF
    Center for the Health Professions
    3333 California Street
    Suite 410
    San Francisco CA, USA 94118

    Phone: 415-502-4991
    Fax: 415-502-4992
    Email Address: sunita.mutha@ucsf.edu

    Biographical Sketch:     Dr. Mutha is a faculty member and primary care physician at the University of California, San Francisco. Her scholarly work focuses on educational and organizational approaches to improving the quality of care for diverse populations. She was the principal investigator for a multi-year project in which safety net hospitals collaboratively applied rapid cycle improvement methods in order to reduce cultural and linguistic barriers to care. Currently she is involved in studies looking at what motivates hospital leaders to make culturally competent care a priority, the feasibility of integrating cultural competence into Pay-for-Performance, and regional mechanisms for increasing capacity among staff and leaders in delivering culturally competent care. She also has extensive experience in developing curricula and conducting cultural competence faculty and leadership training for a wide range of health professionals, including physicians, nurses, pharmacist, and allied health.
Roza Do, BA , California Quality Collaborative, Pacific Business Group on Health, Los Angeles, CA
    Project Manager
    Pacific Business Group on Health
    California Quality Collaborative
    915 Wilshire Blvd., Suite 1620
    Los Angeles CA, USA 90017

    Phone: 213-239-5049
    Fax: 415-284-2754
    Email Address: rdo@pbgh.org

    Biographical Sketch:     Ms. Do is Project Manager for the California Quality Collaborative (CQC) at the Pacific Business Group on Health. She is responsible for managing regional initiatives to improve chronic care and patient experience across outpatient settings in underserved regions in Calfornia, including Inland Empire, Los Angeles and Orange Counties. She has participated in program development and coordinated various quality improvement collaboratives for commercial medical groups and independent practice associations statewide. Her work also includes developing an evaluation framework to measure CQC’s program-wide impact on performance improvement and organizational capacity for 120 target medical groups in California. She also has experience testing and analyzing Pay for Performance measures.
Neil Solomon, MD , California Quality Collaborative, San Francisco, CA
    Clinical Director
    California Quality Collaborative
    665 3rd Street
    Suite 520
    San Francisco CA, USA 94107

    Phone: 415-836-6778
    Fax: 415-587-8950
    Email Address: nsolomon@nasconsulting.biz

    Biographical Sketch:     Dr. Neil Solomon is the Clinical Director for the California Quality Collaborative, where he has developed and directed chronic care, patient experience, and physician leadership programs. He has run the California’s Diabetes CQI Program dedicated to organizational improvement. Dr. Solomon has worked with physicians on communications issues that include exploring the intimate relationship between physician and patient, a core issue in cultural competence. He has also worked with practices on how to support self-management among their chronically ill patients--in which a key component is to understand patients’ own values in order to make self-management relevant and important to them. Furthermore, he has also assisted many physician practices in evaluating their internal operations in order to make their systems more effective for access, care and efficiency. These skills are also important to helping practices integrate culturally appropriate methods into routines and operating procedures.
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