Joining forces to reduce disparities: Lessons learned from the National Health Plan Collaborative

Harvard Pilgrim Health Care, a non-profit health plan based in Wellesley, Mass., provides health insurance coverage and managed care services to over one million individual, group and Medicare members in Massachusetts, Maine and New Hampshire.  Harvard Pilgrim has been rated the #1 health plan in the U.S. by U.S. News and World Report and the National Committee for Quality Assurance for the past three years.

Harvard Pilgrim first began looking for potential disparities in care in the late 1990s through a collaborative health assessment initiative co-sponsored with the MA Department of Public Health and funded by the U.S Centers for Disease Control.  While this initiative enabled the analysis of aggregate health plan data on preventive screening and pregnancy-related quality measures and comparison with benchmarks, it did not permit the identification of individual members, their providers or their communities as needed to target quality improvement interventions.  However, it did provide the information necessary to engage Harvard Pilgrim’s senior management in a discussion of disparities and global strategies that might be taken to help address them. 
In 2004, Harvard Pilgrim became one of ten founding health plans in the National Health Plan Collaborative for Reducing Racial and Ethnic Disparities. In 2005, Harvard Pilgrim implemented a management structure that assures the incorporation of disparities initiatives in our annual quality workplan and performance metrics.

Since that time, Harvard Pilgrim has implemented both global and targeted strategies to:
·         collect self-reported race, ethnicity and language (REL) for our members;
·         apply tools to geo/surname code a proxy race and ethnicity for members for whom we do not have self-reported race and ethnicity data;
·         use both self-reported and proxy REL data to analyze Harvard Pilgrim’s performance on both clinical quality and service metrics and identify any disparities;
·         use REL data to target provider groups and communities for interventions to reduce indentified disparities;
·         use REL data to target member materials for translation;
·         use REL data to assure the availability of interpreter services;
·         incorporate culturally appropriate messaging in our outreach and education materials;
·         implement member, provider and community-based interventions to reduce identified disparities in care; and
·         evaluate the effectiveness of our disparities reduction efforts.