shown that bias is still a problem, as is lack of cultural competency and low health literacy. For example, in coronary artery disease there are disturbing disparities based on race and gender in terms of referrals and treatment. The following panel was designed to provide us with input on ways to improve quality at the provider level by addressing health disparities and health literacy issues.


Grace H. Ting, M.H.A.


The convergence of quality improvement, reducing health disparities, and improving health literacy is the focus of a pilot program at WellPoint, a health plan covering 35 million members. The program gathers data for the purpose of developing profiles of patients with particular conditions, such as diabetes. Data can also help researchers identify factors that could be associated with patient behaviors, such as adherence to treatment protocols, said Grace Ting of WellPoint.

Therefore, the first step of the program is collecting valid data, as discussed by previous speakers. Because collecting this type of data on individual members is often expensive and time consuming, WellPoint developed its Proxy Methodology to identify members of different racial and ethnic groups that may benefit from more focused quality improvement interventions. This methodology combines geocoding and name analysis to develop race and ethnicity estimates that can be rolled up to characterize health care quality improvement needs at a variety of levels, including the regional level, health plan level, and provider practice group level. WellPoint has also engaged physician groups in quality improvement initiatives to address disparities.

Questions have been raised about whether proxy data are good enough for analyses and application in quality programs. As can be seen from Table 4-1, indirect methods have a high degree of accuracy when comparing population groups. WellPoint has conducted extensive testing on the validity of proxy data by comparing internal self-reported data with data generated using the Proxy Methodology.

WellPoint has also conducted some health disparities market research to develop a profile of “adherent” diabetic patients who take proactive care of their health. In the first phase of this three-phased approach, focus groups of adherent individuals were con-

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