Aware that minority populations consistently receive lower quality health care services, officials at Molina Healthcare of Michigan decided that they just couldn’t live with it anymore. In 2006, only 7 percent of the approximately 4,450 African-American males covered in its Medicaid plan got an annual exam. That won’t do, decided James Forshee, MD, the chief medical officer.
“We really had a little bit of concern in telling the world that we were at 7 percent,” says Forshee, “but we felt it was definitely the place where we should be focusing energy.”
Molina worked with the minority health section of the Michigan Department of Community Health in coming up with “Check Up or Check Out!” — an intense educational effort targeting providers and patients. The focus is to link patients directly to their primary care physicians by reaching out in a culturally appropriate manner.
The program, launched in January 2007, was recently named by the National Committee for Quality Assurance as a recipient of an award for “recognizing innovation in multicultural health care.” The NCQA states that “Numerous studies have found that ethnic and racial minorities often receive lower quality health care than Caucasian patients, even when such factors as medical conditions, insurance, and economic status are equivalent.”
Forshee knew where to direct the effort. Eighty percent of Michigan’s African-American males live in or near Detroit, which has the highest morbidity and mortality rates in the state.
Members were provided with an introduction brochure with the doctor’s biography and photo. Personalized letters contained disease management information about prostate health, HIV prevention, and anger, among other things. A “health tips for men” palm card was mailed out at 60 and 75 days. Male Molina staff members made phone calls to remind participants to get their checkups.
Now, about 25 percent of the black men 21 to 64 who participate get a checkup in which they are screened for cholesterol, glucose, colorectal cancer, and prostate cancer.
“One of the biggest barriers was that the men did not want to go in and see somebody they didn’t know,” says Forshee. “The conceptual value of an annual exam for the African-American male didn’t really exist.”
It came down to getting the knowledge to the enrollees, or taking enrollees to the knowledge. “Education was something we could do something about,” says Forshee.
Molina brought together groups of PCPs, took their photographs, and then sent the pictures out to patients who were missing out on preventive services. Which brings us to the most important piece of the program: focus groups of physicians and focus groups of Medicaid recipients. “Those were how we got answers,” says Forshee.
Of course, you have to provide a little incentive for someone, especially a busy doctor, to participate. Forshee says the idea of improved outcomes served as an attraction. Also, the insurer fed them.
“And at those three dinner meetings, we actually took the time with the providers we identified in southeast and west Michigan to share the unsettling data and discuss with them potential solutions,” says Forshee.
The patients got involved in the program thanks to the efforts of Patrick C. Jackson, MBA, the program coordinator of the minority health section at the Michigan Department of Community Health. Jackson, no longer at MDCH, focused specifically on health disparities, says Forshee.
“He was well known and had health care experience,” he says. “We told members what we were doing, brought them together, and provided a meal. We also provided transportation. We got them into those focus groups.”
That led to success.
“It is definitely a partnership,” says Forshee. “And the partnership needs to be with those who have the ability to have an impact on individuals that are your target population. We did the right things by knowing who our patients are and explaining to them that this is about African-American male health issues. Telling them that they have a chance of being part of solving a problem.”
Although the particular hurdles overcome by “Check Up or Check Out!” have to do with the particular market in which Molina launched it, there are lessons for all medical directors, says Forshee.
“I think one of the pitfalls administrative physicians and others make is that we assume we understand the mindset of the people we are creating programs for,” says Forshee. “That assumption gets us into trouble. Using focus groups, we find out that the mentality of the individuals who are in that situation is different from those of us who are trying to go to work in an administrative job day-in and day-out. Using focus groups is very important, especially in Medicaid.”
Forshee says the program should be transferable to other health plans and markets that serve Medicaid recipients. In the meantime, Molina is expanding it to two cities in western Michigan.
“Check Up or Check Out!” has the extra benefit of being inexpensive. Forshee estimates that it cost Molina about $20,000 to launch the program, not counting the hours worked by employees of the insurer.
“This is what managed care should do,” says Forshee. “If we promote good, preventive health care, that will lead to higher quality and cost avoidance. If we can get people with hypertension in before they have their first stroke, what a phenomenal thing. If we can get people in with prostate problems early, get colorectal screening early, and get people in with early diabetes, we can prevent the known complications and occurrences which come from late detection and treatment of these diseases.”
The potential benefits are far too great to not try something like “Check Up or Check Out!” says Forshee.
“Preventive services are foundational to managed care and the more that we can help empower individuals and inform them of what the risks are and what the needs are for their general wellness and for their health, then the better we’ll do as a society and the better we’ll do as a managed health plan.”