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Notes
1. To assist in clear presentation of findings, we have taken the liberty of
condensing the five evaluation questions into four, and rearranging components
of the original questions into groupings that lend themselves better to
summarizing the findings for purposes of this Executive Summary.
2. Specifically, the third of six areas of interest AHRQ defined for the
evaluation asked the evaluator to "measure and assess whether the Collaborative
has reduced or eliminated targeted health care disparities experienced by minorities
in health plans participating in the Collaborative." We concluded, and AHRQ
(and other sponsors and support organizations) agreed that this was unrealistic
within the time frame of the Collaborative. The reframed evaluation questions
eliminated this area of interest, and took into account AHRQ's desire to avoid
burdening participating firms with additional requests for data (Gold et al.
2005).
3. Firms generally found our multiple requests for interviews burdensome (especially in round 2, when we requested substantially more interviews).
Firms often did not distinguish between requests from the evaluation team and
those of the support organizations. They cooperated but asked for fewer
demands in the final round of interviews. Their concerns ultimately also will
influence the shape of the Phase II evaluations.
4. The BCAP initiative encourages plans to organize rapid-cycle quality
improvement work around efforts to identify a target population, stratify by
risk, reach out to members, and intervene, measuring results to provide
formative feedback that can guide future interventions or refinements.
5. RAND uses the term "surname" to refer to their use of enrollees' last names to
identify those of Hispanic or Asian ethnicity.
6. For example, firms that have addressed quality assurance may have many ongoing
initiatives. Their approach to disparities could involve building on these
efforts to enhance their effectiveness in dealing with disparities.
7. One firm used its work with minorities to build grassroots support among
community and church leaders. Another firm told us that an RFP issued by the
National Business Group on Health in early 2005 had a section asking it to
address racial and ethnic disparities as part of the firm's bid. Another firm
said that it had a purchaser with a diverse workforce and therefore viewed
disparities as a high-priority issue.
8. RAND has subsequently refined the method to allow the estimates to reflect
uncertainty about the race/ethnicity of members residing in mixed racial/ethnic
areas. RAND staff believe this change will lead to better estimates of
racial/ethnic composition in heterogenous areas.
9. This firm later decided to make use of geocoding and surname analysis to
supplement its own data. While these analyses are not specific enough to
support member interventions, they provide a vehicle for comparing areas
consistently to identify those that might need to be targeted for
geographically based interventions. The firm saw this as valuable because
reporting was voluntary and could vary by area, and members providing their
race/ethnicity were not necessarily representative of all enrollees in an area.
10. Several reasons limited our ability to do so. First, AHRQ asked us not to
request data from plans, a request most plans would not care to honor in any
case because of its burden. Second, the firms are complex organizations whose
initiatives do not lend themselves to easy characterization in a telephone
interview without supporting documentation. Third, we went into the interviews
with limited knowledge of each firm's efforts. While most firms were
cooperative—and the technical staff involved in geocoding particularly so—we
were covering a broad scope of inquiry and found it challenging to formulate a
set of appropriate questions. Fourth, we interviewed staff who often were
uncomfortable providing us much detail.
11. RAND used what is termed a "deterministic" method of assignment. Members are
assigned either as African American or white/other according to whether the
proportion of such residents in their census block is above or below 60
percent. "Probabilistic" assignment takes into account uncertainty about what
the "true" identifier should be, given the heterogeneity of the population in
the census block. RAND says they have now modified its techniques to include
probabilistic assignment.
12. Though some firms desire RAND to place the tools on the Collaborative web site
for their use, we understand that RAND's ability to do so is limited because
the tools currently are not set up for easy user interface so doing the
conversion would have costs.
13. RWJF has done work in this area independent of the Collaborative. For example,
RWJF funded a policy brief on the legality of collecting and disclosing patient
race and ethnicity data, which was released in June 2006
(www.rwjf.org/files/publications/other/RaceEthnicDisparitiesData06222006.pdf).
14. Because communications activities were just beginning during round 2 of our
interviews, we did not collect information on communications until round 3.
15. All toolkit materials were provided to participating firms in hard copy well as
electronically.
16. In addition to sharing several copies of the toolkit with each of the
participating firms, GMMB has made available selected materials from the NHPC
toolkit in a few other forums, such the Alliance for Health Reform briefing on
racial/ethnic disparities in December 2005 and a Kaiser Family Foundation
briefing on the National Healthcare Disparities Report in April 2006.
17. Information on the number of registrants who actually watched the Web cast
online is not available.
18. In addition, representatives from three firms in the Collaborative are
participating in the CHCS Quality Summit on Improving Health Care for Racially
and Ethnically Diverse Populations in December 2006. This
summit, however, is neither an official Collaborative activity nor sponsored by
the Collaborative per se.
19. The summary report will likely be disseminated elsewhere as well.
20. In summer 2006, GMMB discussed with Collaborative members the possibility of
developing several issue briefs on the Collaborative. Lacking much concrete
detail to disseminate at this stage, GMMB opted to develop a summary report on
the Collaborative instead.
21. The analysis was part of the second round of data collection. We originally
planned to field it again at the end of the Collaborative, but dropped this
plan in response to firms' concern over the burden of participating in the
evaluation.
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