The historic U.S. Supreme Court ruling on the Affordable Care Act represents a major opportunity to level the health care playing field in Connecticut, where communities of color face many daunting health care challenges. For a glimpse of the work ahead for Connecticut, consider the following disparities facing our state:
• Hispanic and African American residents are roughly 5.4 times more likely to lack health insurance compared to white residents.
• Hispanic individuals are 2.5 times more likely to have diabetes than white residents in Connecticut and are 3.8 times more likely to be hospitalized for related complications that require an amputation of an arm, leg or foot.
• African Americans are at two to three times the risk for invasive pneumonia.
• Twenty-two percent of African American women, and nearly 24 percent of Hispanic women, received late or no prenatal care in the first trimester of their pregnancies.
• Asian Americans have tuberculosis 22.5 times the rate of whites.
Health coverage alone is not sufficient to eliminate these health disparities, neither does it guarantee good health outcomes. To ensure true access to quality care and good health outcomes, we must actively attend to implementing the initiatives within the act that specifically focus on achieving health equity.
For example, one of the requirements within the Affordable Care Act is to mandate the collection and use of racial, ethnic and language data. Collecting this data will help us understand population-based health needs for which we can develop targeted solutions to eliminate health disparities. To take this a step further, the act also calls for a commitment to measure, intervene wisely, make improvements and re-measure over time, thus allowing us to hone our practices for better results.
Our commitment, with the help of the promise that the act offers, is to achieve health equity by ensuring that it is treated as an essential, well-integrated element within the health care system going forward. If we do not take this stance, we miss out on valuable opportunities to play a role in reforming a health system where there is no wrong door for gaining quality care.
We need to rethink the business model for health care. A new eye toward "value purchasing," which enables buyers of health care to hold providers accountable for cost and quality, is critical in Connecticut. Achieving this goal requires increased transparency among providers, consumers and the public. Such transparency can only happen with robust data, communication and collaboration among all constituents.
We must demand accountability and reward excellence based on measurable outcomes. To do so, we must develop the necessary information technology infrastructure. The system must have robust data systems, delivery systems and provider networks. With such systems in place, we are obligated by the law to identify and make available data to design, implement and assess improvement efforts — with an eye toward health disparities. Our work requires true focus. Without that focus, the Affordable Care Act will fall short of its potential to achieve health equity.
Much work has been done in Connecticut to prepare for this work. The Department of Social Services and others have already developed a Person-Centered Medical Home initiative, known as PCMH. As a study by the Commonwealth Fund suggests, the relationship between strong primary care and coverage offers the greatest opportunity for improved health outcomes and cost savings. Connecticut has the potential to realize that goal — in the PCMH setting and in integrated primary care practices generally — putting the whole person in the center of care.
With a commitment to hard work, transparency and collaboration, Connecticut has an opportunity to lead on Affordable Care Act implementation. Yet there is no room for error. Residents of Connecticut, including people of color who experience poorer outcomes than others, need the act and the vehicles that Connecticut has only begun to develop to ensure coverage and good health. Now more than ever, the state needs to pay attention to the opportunities at hand and move forward together.
Patricia Baker is president and CEO of the Connecticut Health Foundation in Hartford.
Reprinted with permission of the Hartford Courant.
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