The Southern California Medicare Advantage health plan zeroed in on medication adherence among its Black and Latinx members and took a multifaceted approach, which included cultural humility training and pairing staff and members had language and a cultural background in common.
It seems like everyone is talking about reducing healthcare disparities, but a pair of SCAN Health Plan executives explained how they got out of the talking stage and took concrete steps to reduce disparities in medication adherence at the AMCP Nexus 2021 meeting in Denver.
As described by Sharon K. Jhawar, Pharm.D., MBA, BCGP, chief pharmacy officer of the 220,000-member Medicare Advantage health plan in Long Beach, California, and Timshel Tarbet, MBA, BSP, CCP, vice president of excellence and diversity, some of talk-to-action ingredients included a relatively narrow focus (“not boiling the ocean”), creating a health equity dashboard makes it easy to get disparity-related data and an attitude shift about taking action.
“If we acted, it was one and done and it had to be perfect,” Tarbet said at the session held on Tuesday. Both Tarbet and Jhawar repeatedly characterized SCAN’s effort to address health disparities as a journey that will require adjustments.”
"It is a journey — we are learning so much through this process,” said Jhawar. Tarbet also noted progress in closing the medication adherence gap was a company goal that is tied to compensation: “If we don’t hit it, it affects our paychecks.”
Jhawar and Tarbet shared data showing that there was a 2.9% difference between Black and Latinx members compared with white, Asian and other members on three medication measures. Throughout this year, the difference was smaller and on Oct. 1, it was 1.1%. Medication adherence differences tend to be in single digits; narrowing the gap by 1.8 percentage points is a substantial gain.
Jhawar and Tarbet said SCAN homed in on medication after looking at elements in the CMS Star ratings of health plans and seeing that the plan’s metrics were lower for the Black population overall and that medication adherence metrics were lower for Black and Latinx members. They narrowed the focus even further to medications for diabetes, hypertension and high cholesterol. Jhawar said increasing adherence to statins was the biggest lift among the three categories.
The multifaceted program that SCAN implemented included ethnographic interviews to tease out and identify beliefs and other factors to give health plan managers and employees insights into the reasons for medication adherence issues among Black and Latinx members, Jhawar and Tarbet told the AMCP Nexus 2021 attendees.
Cultural humility training taught the health plan staff to ask patients about their health beliefs and to examine their own views with the goal of improving communication and relationships. SCAN also worked to help members take advantage of existing benefits that improve adherence, such as mail-order delivery of 30-day supplies of drugs. The plan assigned a dedicated enrollment specialist for outbound calls to Black and Latinx members. SCAN also used health literacy tools and included a “fotonovella” developed at University of Southern Carolina that resembles short graphic novels about health issues.
Jhawar and Tarbet said linguistic and cultural pairing were also part of SCAN’s efforts. Linguistic pairing — having a staff member who speaks a member’s language — is fairly straightforward. But Jhawar and Tarbet discussed some of the complexities and sensitivities around cultural pairing because it can, for example, mean that Black staff members would be assigned to Black members. Jhawar explained the evidence and reasoning behind cultural. They said one of the next steps is to look more closely at the Latinx members and disaggregate that grouping to reflect the varied origins and outlooks in the Latinx community.