Research Activities, November-December 2013
State Spotlight: Ohio
Drivers refer to their dashboards to check data on speed and distance. Data-driven researchers and clinicians rely on AHRQ's online dashboards from State Snapshots to gauge the overall status of health care in their State.
The dashboard at the top of each Snapshot provides a needle gauge ranging from weak to strong, which summarizes more than 100 quality measures. Scrolling down the page, researchers and clinicians can compare how a State is doing in types of care, settings of care, common clinical conditions, and specific areas, including diabetes, asthma, and Healthy People 2020.
Research Activities shines a spotlight on how individual States use AHRQ data on health care quality and disparities. Our first columns profiled Iowa and New York. This month we turn to Ohio where AHRQ data is informing ideas to reduce disparities.
Ohio has more than 12 million residents and is the seventh most populous State in the Nation. The State contains major urban areas, including Columbus, Cleveland, and Cincinnati, and a large Appalachian area. It is also home to one of the largest Somali populations in the country.
Real-world frustration in the Buckeye State
"We are in the top quartile for health care spending and the bottom quartile for outcomes," says Mary Applegate, M.D. "That doesn't make sense to me, but it does make sense that we have wide disparities."
Applegate dealt with disparities on a regular basis—first as a pediatrician and internist in rural Ohio and then as deputy coroner for the State. She became medical director for Ohio Medicaid because of what she calls "real world frustration" with disparities. Health care leaders throughout the State share Applegate's frustration—and her commitment to reduce disparities.
"Our State understands that we can no longer afford to do business the way we have been," says Johnnie (Chip) Allen, M.P.H., director of health equity in the Ohio Department of Health and a leader in the National Academy for State Health Policy Leaders. "We have no other choice but to change, but in order to change we have to begin with, 'What is our baseline information?'"
For Allen, many of those answers come from AHRQ. "The AHRQ data is very specific with good research availability. Even if AHRQ has a measure and we don't have a large enough sample, that provides us with insight to enhance our data collection efforts," says Allen. "We want to eliminate disparities. The AHRQ data helps us with what needs to be done. We are working on the how."
A collaborative approach
"About a year and a half ago, a number of State agencies in Ohio, including the Commission on Minority Health, Ohio Medicaid, and our Department of Health met as a collaborative to address health care disparities, particularly as related to the Affordable Care Act," explains Allen. "The AHRQ data provided the opportunity for us to look at the same metrics even though our work is spread across many agencies in the State."
The collaborative approach is changing the way Ohio looks at disparities. For example, Allen says, "We put language in our insurance contracts to address disparities. Prior to that, we didn't have specific language to address disparities."
Another member of the group, Carol Ware, senior program administrator of the Ohio Department of Medicaid, says, "Often states—and I'm not just speaking of Ohio—look for guidance from the Federal level that would help us develop policy. The ACA (Affordable Care Act) and the National Stakeholder Strategy for Achieving Health Equity provided useful information to assist us by giving us a foundation. The fact that we finally could put health equity in our managed care contractual documents is a huge achievement."
Applegate, Allen, Ware, and others are continuing their collaboration by establishing a new group. "Our health equity workgroup will have representatives from managed care, staff from our agency, and partners representing the Commission on Minority Affairs," says Ware. "We have the brains and the willpower, but we all have to come together."
The time is right
"We finally have focused alignment in Federal initiatives, including the HHS Action Plan to Reduce Racial and Ethnic Health Disparities, the National Stakeholder Strategy to Achieve Health Equity, AHQR data resources, and the Affordable Care Act," says Angela Dawson, executive director of the Ohio Commission on Minority Health and one of the health equity group's leaders. "In other words, Jupiter is finally aligned with Mars."
Dawson should know. "The Ohio Commission on Minority Health was the first State agency set aside in the nation to look at minority health disparities," she says. "We've been on the battlefield for 26 years helping to push efforts toward policies that drive down minority health disparities and raise awareness of health disparities while improving the health of racial and ethnic minorities."
"What's different now", says Dawson, is that "Ohio recognizes that we can't afford to do business the same old way. Rather we must begin to use data to drive our policy, allocation, and implementation decisions. Our exorbitant spending forces us to both challenge and change the historical approach of scattering money across the State without the real means to assess the impact of our investments."
Dawson sees this opportunity as the "greatest time for growth in the history of health care disparities since the release of the 1985 Heckler report." (http://go.usa.gov/WB3C).
Champions in Ohio
"The best data can only help identify key problems," says Ernest Moy, M.D., senior research scientist at AHRQ. "Champions are essential to lead the hard work of improving quality and reducing disparities."
AHRQ data--reports States use
Every year since 2003, AHRQ has released the National Healthcare Quality Report and the National Healthcare Disparities Report. These Congressionally mandated reports gauge the state of health care in the United States. More than 250 measures relating to quality of care and access to health services are factored in and reported by racial, ethnic, and socioeconomic groups.
In 2005, AHRQ began compiling data from the reports to develop an annual State Snapshots, which provides State-specific health care quality information, including strengths, weaknesses, and opportunities for improvement. Every State and the District of Columbia can compare their own health care statistics with the Nation as a whole.
The State Snapshots can help State officials and their public- and private-sector partners better understand health care quality and disparities in their State. Ultimately, the goals of these reports, combined with other Department of Health and Human Services initiatives such as the National Quality Strategy and the Disparities Action Plan, is to make the lives of patients and families better.
To view the quality and disparity reports, visit http://www.ahrq.gov/research/findings/nhqrdr. To view the State selection map and explore the quality of your State's health care against national rates or best performing States, visit http://statesnapshots.ahrq.gov.