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Uninsured Populations: Improving Care and Outcomes

Explore the invisible disparity in healthcare for the uninsured. Learn about quality improvement initiatives to address this crucial issue and the financial and health consequences faced by patients. Discover actionable strategies for better care.

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Uninsured Populations: Improving Care and Outcomes

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  1. AHRQ 2009 Annual ConferenceResearch to Reform Improving Care and Outcomes in Uninsured Populations: The Invisible Disparity Randall D. Cebul, M.D. rdc@case.edu

  2. Overview: Quality of Care Among the Uninsured • Without claims or EMRs, the quality of care and outcomes of the uninsured are largely invisible. • Yet we know they fare more poorly • Practice records-based measurement and public reporting are important for improving quality. • EMRs are useful: timely, granular, enable CDS • HIE (interoperable EMRs) would be even better • Linked to regional QI/consumer engagement (CE)/payment reform, better still • RWJF is supporting 15 communities to measure and report performance, undertake regional QI and CE

  3. We know how many uninsured there are. 15.4% (46M), growing: 26% if publicly insured are excluded http://www.census.gov/ accessed 9-12-09

  4. We know some of the financial and health consequences – to patients • Medical bill problems/paying off medical debt climbed from 34 percent to 41 percent in the U.S. between 2005 and 2007... 72 million (Commonwealth Fund) • Medical costs are the leading cause of personal bankruptcies (Himmelstein, AmJMed. 2009) • roughly half of all bankruptcy filers (‘07) had OOP medical costs > $5000 before filing; 3/4 had insurance coverage • Lack of insurance leads to foregoing necessary care • IOM: 20,000 premature deaths annually • NONE OF THESE ARE VERY ACTIONABLE STATISTICS

  5. “Poor Glycemic Control” Among Diabetics: The Uninsured do Worst • 6843 patients • One EMR-based system, same PCPs • Uninsured: 64% higher odds (95% CI: 1.32-2.03) of poor control • Adjusted for ASR, co-morbidities, smoking, show rates, income, site of care Supported by grant: R01 HS-015123, Agency for Healthcare Research and Quality

  6. Aligning Forces for Quality - 2008

  7. AF4Q in NortheastOhio

  8. Measurement Matters • Public reports every 6 months • NQF endorsed, locally vetted measures • Diverse practice organizations and sites • “Care Alliance to Cleveland Clinic” • 8 organizations, 54 sites (42 reporting), 500+ PCPs (361 reporting) – virtually all SNPs, all FQHCs • Paper-based practices manually abstracted .. • Region-wide Achievement and Change by: • Insurance(M’care, commercial, M’caid, uninsured), Race (W, B, H, Other), Income and Education (addresses geo-linked to census) • Practice site achievement and change by insurance

  9. Diabetes - 2008

  10. 19% Increase in Uninsured,2007 to 2008

  11. Vs. HEDIS. Uninsured do ok – compared to Medicaid *Lower rates are better for this measure.

  12. Overall, we’re improving on our composite measures

  13. And most practices have betteroutcomes and better care processes

  14. But our Uninsured are not Improving

  15. Thank you Visit our website: http://www.betterhealthcleveland.org

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