Addressing Racial and Ethnic Disparities in the Context of
Medicaid Managed Care: A Six-State Demonstration Project

Next Steps

Some of the States participating in this project, and some other states as well, are expanding the work on disparities and culturally and linguistically appropriate services to include attention to these issues as an ongoing part of their quality measurement and quality improvement programs. We can expect to see more States, and more health plans within those States, taking on the kinds of projects reported here in the very near future.

In order to enhance the number and quality of future quality improvement initiatives aimed at reducing or eliminating disparities, state Medicaid programs can consider taking some or all of the following steps:

• improving the completeness and accuracy of race/ethnicity data collected at the point of program eligibility/enrollment;
  
  
• where appropriate, adding racial/ethnic "sub-categories" (e.g, Mexican or Dominican as sub-categories of "Hispanic") in order to facilitate use of culturally and linguistically appropriate quality improvement approaches;
  
  
• including data on primary language in the process of collection and transmission of race/ethnicity data;
  
  
• making participation in disparity-reduction initiatives one of the contractual requirements for health plans' participation in the Medicaid managed care program;
  
  
• encouraging plans, particularly those with overlapping provider networks, to collaborate in terms of QI initiative planning, outreach to providers and community partners, and data analysis for program evaluation;
  
  
• providing technical assistance workshops for health plan quality measurement and quality improvement staff to assist in development and evaluation of QI initiatives;
  
  
• using state-level quality of care data to supplement plans' own data for purposes of QI program evaluation.

The experience of health plans in this project has encouraged the development of at least two similar projects that will expand the number and type of plans involved. A project funded by the Robert Wood Johnson Foundation and organized by the Center for Health Care Strategies (CHCS) is currently accepting applications from Medicaid managed care plans to participate in a project using the Best Clinical and Administrative Practices (BCAP) methodology to address disparities in quality of care. The project will involve essentially the same structure as that described here, but the BCAP approach to quality improvement will be more explicitly part of the project and there will be more attention paid to opportunities for state-level analyses of data for purposes of identifying and understanding disparities and assessing effects of plan-level interventions.

A second project that is being considered for funding by a major private foundation is extending the experience of this project to large private sector health plans and private employers. Again, the key steps of baseline data analysis to identify disparities, planning and implementation of QI initiatives, and follow-up data analysis to assess impact of interventions will be used to determine whether plans can have a significant effect on reducing or eliminating disparities. A key methodological challenge is the lack of race/ethnicity data coming from a single purchaser; plans will have to use a variety of methods to obtain the data that in this project came from the state Medicaid programs.

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