Addressing Health Disparities through Innovations in Managed Care

Editor’s note: The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the Aging and Disability Business Institute, led by the National Association of Area Agencies on Aging (n4a). The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and n4a are collaborating on a series of articles and case studies in Generations Today that highlight community-based integrated care networks.


Jointly sponsored by n4a's Aging and Disability Business Institute (Business Institute) and ASA, the Managed Care Summit: Unpacking Health Disparities, happened April 9 at On Aging 2021, but can be viewed at any time for conference attendees who missed it the first time around. And it’s well worth it to hear of multiple successful innovations at work to address health disparities at the national, payer, and community organization levels.

Marisa Scala-Foley, director of the Business Institute, kicked it off as moderator, describing ADBI’s mission to build the capacity of community-based organizations (CBOs) to contract with healthcare entities.

“The twin pandemics of COVID and health inequity were at the forefront this year, and moving into the post-pandemic world we will be looking at the lessons learned as a field,” Scala-Foley said.

Rani Snyder, vice president, program for The John A. Hartford Foundation, which funds the Business Institute, explained its pillars of building age-friendly health systems, supporting family caregivers, improving serious illness and end-of-life care. In the second phase of the Business Institute's work, Snyder said the results were better access to services, nutritious meals, personal care, transportation, caregivers, and allowing elders to remain in their homes and be independent. So far, more than 44 percent of CBOs have garnered contracts with healthcare entities.

“The next round encompasses creating and integrating a seamless, age-friendly health system.” Hartford envisions this as an evidence-guided social movement to ensure all care for older adults is age-friendly. Age-friendly systems that use Hartford’s 4Ms framework (What Matters, Medication, Mentation, Mobility) are growing rapidly, with sites in each state. The 4Ms were in use this past January in 1,956 hospitals, and clinics, PACE sites and nursing homes. Already by April there were more than 2,000 care sites, Snyder said.

Tricia McGinnis, executive vice president and chief program officer at the Center for Health Care Strategies (CHCS), addressed fixing disparities and advancing equity via value-based payment in managed care. One illustrative example of how this might work was an attempt to improve post-partum care for people of color by paying physicians a small annual bonus for women who received a post-partum visit. Also, the plan or provider funded a social worker and bilingual case manager to support the patient, and gave patients small financial incentives in the form of metro or gift cards for attending a post-partum visit.

‘So why would a healthcare system think about addressing the social determinants? For us we think it’s the right thing to do.’

McGinnis also mentioned bringing in a CBO experienced with homelessness to help CHCS assess homeless families to figure out barriers to care, and the group is now in the process of developing a wraparound model to  help homeless families overcome those barriers.

Deanne Minus-Vincent, senior vice president and chief Social Integration and Health Equity for RWJBarnabas Health, brought the discussion to the personal level by asking and answering why she does this work. Her answer? Because of people like those in her family who were active in the civil rights movement, and encountered personal health issues such as maternal mortality, plus her own path to health through weight loss.

“So why would a healthcare system think about addressing the social determinants? For us we think it’s the right thing to do,” Minus-Vincent said.

Not only does RWJBarnabas Health purchase, hire and invest locally, but the health system realized it needed to focus on housing, food, education and workforce development as well. Now it’s working patient by patient with a Health Beyond the Hospital program, which screens every patient for social determinants in a clinical setting.

Also, within the Health Beyond the Hospital umbrella is a program called Ending Racism, led by Minus-Vincent. “Because of the social unrest, plus the pandemic, we needed to accelerate what we were doing,” she said.

Stephanie Franklin, the Population Health Strategy Lead at Humana took over the Zoom screen next, detailing the work Humana is doing to help people realize their best health through addressing key disparities via new ways of understanding and meeting  social needs. Called the Bold Goal, it is Humana’s population health strategy to make it easier for everyone to achieve their best health through community, clinical and business integration. Humana is expanding this effort by launching “Louisville Community of Opportunity” in its headquarters city, collaborating with new and existing partners in Louisville’s West End to focus on health equity.

The CBO Perspective

Later in the program Arielle Basch, senior director of Health Services at JASA and Shireen McSpadden, executive director of San Francisco’s Department of Disability and Aging Services (DAS), spoke of successful innovations on the CBO side related to health equity.

JASA has realized a 26 percent reduction in readmissions.

JASA’s Hospital to Home program sprung up out of a need to prevent older adults from being readmitted to the hospital by helping them to understand discharge instructions, which often are in a language foreign to them. Using International Medical Graduates (IMG) who are native speakers of the languages common to the part of New York City where JASA operates, they have realized a 26 percent reduction in readmissions.

On the flip side, the IMGs gain priceless training in geriatrics, which hopefully they will use in the field once they move on to residencies. IMGs also pay home visits to clarify medication mix ups and ascertain other services that may be necessary to preserve the older adults’ health.

McSpadden addressed her agency’s approach to using an equity lens in social services. For starters, they needed to name the importance of equity, she said, so DAS and its parent agency named equity as a core value and made a public statement about its principles to support and shape the work. They published a 90-item racial equity action plan, which is currently being implemented.

“We delve through the data to understand how LGBTQ+ communities and communities of color are using various programs. … When we see gaps we engage with the community to find out what’s going on, which programs people don’t want, which they do know about and how to fix them. It’s been really informative,” McSpadden said.

This spring DAS is conducting a series of BIPOC research projects to help them better understand the needs of BIPOC older adults.

This Summit was chock full of useful ideas to take back to other agencies, and we highly recommend watching it.