BlueCross BlueShield of Tennessee developed a tool kit for churches to use to improve immunization rates among minorities and rural whites in the state. Next up: Behavioral health and chemical dependency problems.
BlueCross BlueShield of Tennessee is working with churches and other faith-based organizations to improve its HEDIS scores related to childhood and adolescent immunizations for its members.
Through its BlueCare Tennessee subsidiary, which manages 450,000 Medicaid members, BCBSTN is partnering with the faith-based community to address the immunization disparities that exist within minority populations and the rural white population in the state. In 2012, less than one-quarter of African-American children (21%) and only 11% of Hispanic children in Tennessee received the recommended immunizations.
HEDIS, the Healthcare Effectiveness Data and Information Set, is a set of 75 measures across eight domains of care, developed by the National Committee for Quality Assurance to measure health plans' performance on care and service. HEDIS is used by more than 90% of U.S. health plans.
Earlier this year, the Blues plan established a 12-member disparities advisory board comprising local experts and community leaders to help the insurer develop a course of action to address a wide range of healthcare disparities, including the immunizations gap. Rafielle Freeman, director of quality improvement for BlueCare, says the committee came up with the idea of approaching pastors and churches as a way to reach minorities across the state.
"Tennesseans listen to their pastors and ministers," she explains. "The faith leader's voice can be powerful in promoting good health."
The Lifting our Members program includes a free tool kit that can be used within faith-based communities to help their individual congregations learn about the importance of childhood immunizations, preventive care, women's and men's health, and behavioral health.
Trained volunteers—mostly Blues employees—have distributed the tool kits and trained congregations at more than 200 churches in communities identified through the data analysis of ZIP codes as having the greatest disparities.
Freeman says she works closely with the analytics team at BCBSTN to develop the information the volunteers need to convince churches to support this effort. "We have to make sure the pastors and ministers see this as something beneficial." Customizing information by ZIP code makes the program "more powerful to them. It really brings it home when we can tell them what's happening in their local community."
In addition to volunteers, BCBSTN employs several community care partners in the focus communities who also do outreach to the congregations by organizing health fairs at which providers are on hand to help with immunizations and preventive screenings. The insurer also appeals to its provider network members to open their offices some Saturdays for shots and screenings.
Freeman notes that transportation is often an issue for the Medicaid population, so her team works with transportation vendors to help families get to medical appointments and keep their children up to date with scheduled shots.
Although Freeman says focusing on healthcare disparities is simply "the right thing to do" and that the Lifting Our Members program has plenty of C-suite support at BCBSTN, she is also keenly aware that she needs to make a business case for the program and its budget. Success of the initial focus on childhood immunizations will be measured in several ways. Improvement in HEDIS measures related to childhood and adolescent immunizations is critical, says Freeman, because "for managed care organizations, that really is the only way we can get an apples-to-apples comparison across health plans on how we're doing." She says they will look at the HEDIS measures across all lines of business to see if there is an impact. Immunization levels among ZIP codes where the tool box is used will be compared to those where it is not used.
The goal is to get the tool boxes in 1,000 churches and to expand the effort to behavioral health and chemical dependency next, and then women's health, including maternity.
Freeman describes as "staggering" the rate of behavioral health and chemical dependency problems among minorities in the state, with 53% of non-Hispanic whites, 46% of African-Americans, and 31% of Hispanics having a problem. "If you think about it, those are just the people who are accessing the healthcare system. In every community there are all kinds of stigmas associated with behavioral health. We want to tackle that next to encourage seeking help and getting counseling and treatment."
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
