How does HealthPartners reduce disparities between patient populations?

Beth Averbeck, MD; Associate Medical Director for Primary Care, HealthPartners

Our goal is to reduce the gap while improving care for all. So when you look at reducing the gap, one way to do it is to decrease your performance for one cohort while either staying the same or increasing for another. So we talk about it in improving rates for everyone while reducing the gap.

For example, we have our goal of reducing the disparities gap in mammography. We had one clinic that came up with this bright pink ticket idea. They call it their pink ticket for the mammogram. The work flow is that the radiology tech looks at the schedule the day before, and cues the scheduling or reception staff as to who needs a mammogram. When that patient comes in the receptionist gives them a bright pink ticket and says, “I see you’re due for a mammogram today, why don’t you get it, here’s your pink ticket, we’ll make sure you get it today.”

Well, that pink ticket also serves as a decision aid for the nurses and for the physicians and clinicians to recommend the mammogram, so when the visit’s done, the nurse escorts the patient to the mammography area and introduces them to the mammography tech, who then takes the patient to get the mammography. This was a test of change that was developed by the receptionists and the nurses and the radiology techs. Well, they got their gap to less than one percent — one clinic trying one simple test of change that we’ve now spread to other clinics.

How does this approach compare to traditional health care?

When I trained and when I started, we were trained and we set up our clinic systems to have preventive visits, and then we would have chronic care visits, and then we would have acute care visits. So it was very possible that a patient might come in for a diabetes visit and we didn’t realize they were in need of a mammogram, and so we’d be chasing them afterward trying to get them back in. But patients don’t think of themselves as this is my preventative visit, this is my diabetes visit, this is my visit for my back pain, and so when we re-did our work flows we said, every patient, every visit, and what’s the recommended care. So if a patient comes in for back pain, we’re recommending any preventative services they need, we’re dealing with the diabetes care that they might need, and we’re using the full care team members, where most of this used to fall under the physician or nurse practitioner, it’s now the nurse, the scheduler, everybody helping to identify the needs for that patient and supporting that patient.

Can reducing health disparities improve an organization’s bottom line?

In our state and in our country, we’re becoming more diverse, and we certainly need to improve the care for our patients, but it’s also about having it be a welcoming organization and having our patients feeling confident and comfortable in our care. So from that standpoint, yes, because it helps us grow our organization.

In the case of mammography, when we’re doing same-day mammograms, I think we’ve done over 6,000 same-day mammograms in the course of a year. Well, that helps the bottom line, and it’s recommended care. It’s not overuse. So by doing this it’s the right thing to do, and it helps us with Triple Aim, both from the standpoint of quality patient experience, affordability because we’re catching disease early, and then also even from the bottom line from where recommended care isn’t being done then we’ve got the opportunity to provide that as well.