The National Health Plan Collaborative: Overview of Its Origins, Accomplishments, and Lessons Learned
I. Description of the National Health Plan Collaborative
When the Nation's policy and clinical leadership set its sights on overcoming the "quality chasm,"1 it was perhaps inevitable that concern soon would grow over disparities in access to and quality of health care.2 The formation of the NHPC in mid-2004 was one response to this concern.3 From its inception, the NHPC sought to provide an opportunity for firms actively engaged in sponsoring health plans to collaborate in reducing racial and ethnic disparities in health care. The NHPC was launched in July 2004, and the first phase of work ended in September 2006. AHRQ then sponsored a second phase, which ended in September 2008. AHRQ's sponsorship of the NHPC has ended, but NHPC firms are sharing their experience in disparities reduction under the auspices of AHIP.
Nine firms participated in the NHPC during its first phase. Five of the nine were large national firms operating health plans in many regions: Aetna, CIGNA, Kaiser Permanente, UnitedHealth Group, and WellPoint. Four of the nine were regional firms: Harvard Pilgrim Healthcare of Massachusetts, HealthPartners of Minnesota, Highmark Blue Cross Blue Shield in Pennsylvania, and Molina Healthcare, Inc., headquartered in California. All but Molina (in which Medicaid is dominant) serve a diversified market and have substantial commercial business. In Phase II, the NHPC was expanded by the addition of a sixth national firm—Humana— and a fifth regional organization— BMC HealthNet, located in Massachusetts.ii By the end of Phase II, the NHPC included 11 national and regional managed care firms encompassing approximately 87 million covered lives.iii
The plans became involved in this initiative in a variety of ways.iv Some had attended meetings on racial and ethnic disparities, sponsored by AHRQ or other organizations. Others were known to be forward thinking, with a strong interest in disparities, and were invited to participate by NHPC sponsors or support organizations.4-5
The NHPC received support from several organizations throughout its history, as arranged through various contracts with support organizations, AHRQ, and RWJF. The Center for Health Care Strategies (CHCS) was responsible for organizing the NHPC process, working closely with health plans to do so. RAND provided critical substantive support to the NHPC's efforts to understand, measure, and monitor disparities.v In practice, both organizations worked closely with each other, and with the sponsors, to support the NHPC. Additional support was provided during Phase I by the Institute for Healthcare Improvement (IHI), a leader in clinical quality improvement with experience mainly on the provider side. GMMB, a communications firm, became involved in July 2005 and helped the NHPC to disseminate its work through the end of Phase II.vi
Phase I of NHPC ran from July 2004 through September 2006. During this time, the NHPC focused primarily on health care disparities among plans' commercially enrolled members (rather than those members with various forms of public coverage, such as Medicare and Medicaid). The NHPC targeted disparities in diabetes care, given that diabetes is a condition known to affect a relatively large proportion of the population and a disproportionate number of racial and ethnic minorities. Diabetes is also a condition for which quality measures (specifically Healthcare Effectiveness Data and Information Set [HEDIS] measures) are readily available. In Phase I, NHPC sponsors and support organizations encouraged firms to develop and test small-scale pilot interventions for members with diabetes-a step for which many were not yet prepared. While the development of interventions occurred slowly and collaboration between participating firms was less than expected during the first phase,6 by the end of Phase I, disparities measurement and reduction activities seemed to be gaining traction within participating plans; the Collaborative as a whole also appeared to be gathering momentum. As a result, AHRQ agreed to fund the NHPC for 2 more years.
The NHPC's second phase ran from September 2006 through September 2008. Its intent was to increase the specificity and clarity of objectives, with a focus on particular activities that firms agreed were important. Plans collectively agreed to focus on three areas:
- Collecting primary data on race and ethnicity.
- Providing language services.
- Developing the business case for work on disparities, both nationally and within firms.
While work on the business case7 never materialized (primarily because of a lack of clarity about this work and the fact that it did not necessarily lend itself to group work), the Collaborative maintained its focus on the other two areas throughout Phase II. A little more than halfway through Phase II, the NHPC participants organized themselves around three task forces to focus the group's efforts for the remainder of Phase II: sustainability of the NHPC beyond Phase II, standardized data collection, and regional collaboration. Ultimately, the NHPC realized the need for setting priorities for its remaining time and focused primarily on the first two task forces. (Ideas for regional collaboration were the least developed of the three task forces and the most tangential to other Phase II work).
Collaborative activities in Phase II took the form of three in-person meetings, as well as conference calls (generally held on a monthly basis) on specific Phase II activities or special topics. In the final months of Phase II, the NHPC devoted substantial resources and energy to the discussion of its post-Phase II transition.
Although the transition is not part of the evaluation, since fall 2008, AHIP has convened conference calls of NHPC firms regularly to provide policy updates relevant to disparities activities. AHIP also has hosted a Web conference on race/ethnicity/language data collection, in which several NHPC firms presented their data collection work to other AHIP member plans. Firms report that AHIP has focused on educating its members on the collection of data, and AHIP is effectively tapping NHPC firms as a resource. Momentum for targeted work in this area has been affected by the demands of changes in national political leadership, the consideration of possible national health reform, and the recent serious economic downturn. Despite these events, firm representatives continue to see strong potential for the NHPC under AHIP's guidance.
Appendix A provides a timeline for the NHPC, including the activities leading up to its formation and those that occurred during both phases of work.
iiHumana and BMC HealthNet joined the NHPC in June 2007 and October 2007, respectively.
iii For more information, go to www.nationalhealthplancollaborative.org and refer to Lurie N, et al. The National Health Plan Collaborative to reduce disparities and improve quality. Jt Comm J Qual Patient Saf 20088;34(5):256-65.
iv For more information on the origins of the NHPC, refer to Gold M, Doreian P, Taylor EF. Understanding a collaborative effort to reduce racial and ethnic disparities in health care: contributions from social network analysis. Soc Sci Med 2008;67:1018-27.
v In Phase I, CHCS and RAND had separate support contracts, the former from RWJF and the latter from AHRQ. IHI was a subcontractor to CHCS in Phase I. AHRQ provided the main support in Phase II, with a contract to CHCS, which then subcontracted to RAND.
vi RWJF provided communications support throughout the NHPC via a contract with GMMB.