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					                          MINNESOTA HEALTH PLANS:
               Working to Eliminate Racial and Ethnic Health Disparities

The Issue:
According to a 2003 Minnesota Legislative report disparities in health status between the
majority population and populations of color are, in some cases, getting worse. Because
disparities result from the interplay among multiple factors including access to health care,
genetics, racism, poverty, and health behaviors, a community response is needed.

The Purpose of the document:
This is a working document of Minnesota Council of Health Plans (MCHP)* that provides
examples of programs and activities directed at eliminating racial and ethnic health disparities.
This document does not capture every program or activity that health plans offer nor does it
provide information on activities or programs unique to an individual health plan. The purpose
of the document is to identify common areas of work across health plans, identify gaps, and,
from that information, determine actions that MCHP’s members may work on collaboratively.

The MCHP (www.mnhealthplans.org) vision statement recognizes the importance of addressing
disparities: “Health Plans should work with government and health care providers to improve
health status, reduce disparities, and improve the mental health system.” Through the
identification of health disparities programs that are common across health plans, this document
provides an important first step for health plans to further identify effective collaborative
activities.

Minnesota health plans offer various services and programs to address racial and ethnic
disparities. However, each health plan is unique in terms of the numbers and type of people
served, its geographic area, and its focus on commercial or government program products, such
as Medicaid and MinnesotaCare. Because of these differences, programs and activities vary
across health plans.

The following list provides examples of the types of programs offered by Minnesota’s health
plans. The list is not comprehensive. To learn more about health plan-specific initiatives focused
on eliminating racial and ethnic health disparities refer to the contact persons listed on page 5.




                                                              ---
*MCHP Members: Blue Cross Blue Shield/Blue Plus of Minnesota (BCBSM); First Plan of Minnesota;
HealthPartners; Medica; Metropolitan Health Plan; PreferredOne; Sioux Valley Hospitals and Health System;
UCare Minnesota




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                          MINNESOTA HEALTH PLANS:
               Working to Eliminate Racial and Ethnic Health Disparities


Minnesota Health Plans are addressing racial and ethnic disparities though employment:

Staff Training and Education:
 Offer diversity training to all employees.                       Preferred One offers employees “Lunch and Learn”
                                                                   presentations that focus on awareness and
 Provide materials/resources on cultural
                                                                   appreciation of cultural differences. New employee
   competence.                                                     orientation includes information on diversity.
 Organize diversity celebrations/activities on                    There also have posters and bulletin boards
   different cultures throughout the year.                         displaying various cultures and ethnic groups.
 Offer ongoing training sessions to employees
   regarding culturally competent care.

Employee Recruitment:
 Actively recruit by advertising                          UCare’s Cultural Competence Plan addresses all 14 CLAS
  jobs/positions in diverse publications                   standards. Twenty one percent of UCare’s employees are
  and at job fairs and community                           persons of color or American Indian. UCare also received a
                                                           national award for their Hmong Outreach Program, aimed at
  festivals.                                               bridging the cultural gap separating the Hmong population
 Identify workforce diversity goals.                      and U.S. health care practitioners.

Employee Retention:
 Have internal diversity committees to foster supportive working environment for diverse
  staff to help retain them.

Minnesota Health Plans work to increase access to culturally and linguistically appropriate
care through:

Interpreters:
 Provide interpreter services for health care      HealthPartners operates the Center for
                                                    International Health at Regions Hospital, which
   services.                                        offers a wide range of medical services, with a
 Offer language assistance both in person and      focus on international medicine and assisting new
   over the phone.                                  immigrants adjust to Minnesota’s health care
 Employ bilingual staff, especially in             system. Providers at this clinic are trained in
                                                    tropical and travel medicine and cross-cultural
   customer services.                               health and are dedicated to providing culturally
 Publish provider directories that indicate        competent care. In additional to usual clinical
   language capacity of clinics.                    care, other services offered include: post traumatic
 Publish notice of right to interpreters in        stress disorder, torture victim services, and
                                                    Vietnamese culture and language-specific services.
   member guides.
 Disseminate posters or other notices to place in clinics to help patients indicate their need for
   interpreter services.
 Include language block on all member materials explaining how to get the information
   communicated in their language.
 Include interpreter services information (e.g., how to arrange for interpreters, how to work
   with interpreters, etc.) in provider materials.
 Review interpreter services policies and procedures annually.


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                          MINNESOTA HEALTH PLANS:
               Working to Eliminate Racial and Ethnic Health Disparities


Written Materials in Other                            The Medica Foundation has as one of its three priority areas,
Languages:                                            “Reducing Disparities in Healthcare.” Examples of grants
 Provide materials in identified                     provided in 2003 included piloting bilingual health education
   languages and respond to requests                  curriculum in four languages for parents with small children and
   for special language needs.                        a program that provides advocacy services and outreach to East
                                                      African families in selecting and utilizing a primary care clinic.

Facilitating Complaint Process:
 Notify members of their right to file complaints or grievances in member information.
 Provide interpreter services for complaint and grievance process.

Prioritizing the Issue:
 Have internal Health Plan cultural competence committees.

Soliciting Community Input:                       The Blue Cross Foundation issued grants in 2003 focused
 Convene Member Advisory Committees              on helping people with unique cultural needs. Grants
                                                  include: health programs for low-income African
    to receive ongoing input about services.
                                                  immigrants infected with HIV, a program that provides
 Hold focus groups among diverse                 culturally specific activities for Native American youth; a
    members to solicit feedback from              mental health services program for Hmong; a study of the
    particular population groups.                 uninsured in Minnesota.
 Participate in diverse community events
    and health fairs to have a presence in the community.

Minnesota Health Plans work to improve the quality of care of diverse populations
through:

Provider Education:
 Offer cultural competence training for health care               First Plan of Minnesota co-sponsors
                                                                   diversity workshops for regional
   providers (e.g., sponsor conferences, workshops and onsite      primary care provider staff.
   clinic training sessions).
 Offer conferences on best practices, screening, health disparities
 Provide materials/resources on cultural competence.

Quality of Care Improvement Initiatives:
 Address cultural needs in quality improvement                          Metropolitan Health Plan arranged for
  initiatives.                                                           Somali patients to visit clinics where Somali
 Consider available ethnic data in planning                             medical professionals are on staff.
  initiatives.

Data Review:
 Review public programs data on race and language as part of their program planning process.
 Review published data and community assessments/surveys on cultural and linguistic needs
   of Minnesota populations as part of their program planning process.


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                          MINNESOTA HEALTH PLANS:
               Working to Eliminate Racial and Ethnic Health Disparities


          Examples of Collaborative Projects Addressing Health Disparities
                        Minnesota Council of Health Plans

      Minnesota Health Plans lead or participate on many collaboratives that focus on
             eliminating racial and ethnic health disparities. Examples include:

Community Health Worker Policy Council: The Council is advancing the role of the community
health worker in the public and private health and human services sectors and developing
recommendations for policies and strategies to incorporate the workers into the care delivery systems.
Health plan members include: Blue Cross Blue Shield/Blue Plus of Minnesota, Medica,
HealthPartners and UCare Minnesota (Carol Berg, chair).

Minnesota Health Care Disparities Task Force: This is a task force convened by the Minnesota
Department of Health and Department of Human Services in 2004 to cooperatively address health
disparities across health systems in Minnesota. The vision of this task force is that "culturally and
linguistically appropriate health care services will be delivered to all Minnesotans". The task force has
three work groups that are articulating recommendations regarding: race/ethnicity and language data
collection and analysis; access to health care services; provider services and clinician education. Health
plan members include: Blue Cross Blue Shield/Blue Plus of Minnesota, HealthPartners, Medica,
and UCare Minnesota.

Hmong Health Care Professional Coalition: This network of Hmong health care professionals
organizes a number of community based health education initiatives addressing the particular needs of the
Hmong population. Among these activities is the annual health component of the annual Hmong Soccer
Tournament that attracts thousands of Hmong from across the country. Health Plan members involved
in this Coalition include: Blue Cross Blue Shield/Blue Plus of Minnesota, Medica, HealthPartners
and UCare Minnesota.

Interpreting Stakeholders Group: (convened through the Upper Midwest Translators and Interpreters
Association). The mission of this group is to improve the delivery of spoken-language interpreter services
in Minnesota, and to promote the professionalism of the interpreting industry as a whole. Their goal is to
achieve equal access to health care and human services for clients with Limited English Proficiency
(LEP). Health Plan members include: Blue Cross Blue Shield/Blue Plus of Minnesota,
HealthPartners, Medica, Metropolitan Health Plan and UCare Minnesota.

Multilingual Health Resource Exchange: This is a public/private collaborative that is establishing a
web-based clearinghouse of written and audiovisual health resources in the languages most common in
Minnesota. Health Plan members include: Blue Cross Blue Shield/Blue Plus of Minnesota,
HealthPartners, Medica and UCare Minnesota. For more information, go to www.health-
exchange.net.

Twin Cities Healthy Start (TCHS): This initiative is focused on providing holistic, respectful,
culturally competent community clinic service that can be replicated throughout the Minneapolis and St.
Paul perinatal system. The Council’s Community Health Committee arranges health plan
representation for the TCHS Collaborative. The following health plan members participate in the TCHS
Maternity Manager’s Committee: Blue Cross Blue Shield/Blue Plus of Minnesota, HealthPartners,
Medica and UCare Minnesota.

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                          MINNESOTA HEALTH PLANS:
               Working to Eliminate Racial and Ethnic Health Disparities

For additional specific examples of health plans’ initiatives to address health disparities you may
contact individual health plans listed below.

Health Plan Contacts:

Blue Cross Blue Shield/Blue Plus of MN                            Metropolitan Health Plan
Teresa A. Schaffer                                                Arif Altaf
Regional Coordinator                                              Outreach Manager
(651) 662-1868                                                    (612) 347-4894
teresa_a_schaffer@bluecrossmn.com                                 arif.altaf@co.hennepin.mn.us

First Plan of Minnesota                                           Preferred One
Barbara Eaton                                                     Joni Riley
Director of Public Programs                                       Dir. of Quality Improvement and Medical Policy
218-529-9959                                                      (763) 847-3238
barbara_eaton@bluecrossmn.com                                     joni.riley@preferredone.com

HealthPartners                                                    Sioux Valley Hospitals and Health Plan
Donna Zimmerman                                                   Lisa Carlson
VP of Government and Community Relations                          Director of Government Programs
952-883-5377                                                      605-328-6859
donna.j.Zimmerman@healthpartners.com                              carlsoli@siouxvalley.org

Medica                                                            UCare Minnesota
Kenneth Bence                                                     Carol Berg
Director of Community Health                                      Public Health Manager
952-992-8380                                                      612-676-3635
kenneth.bence@medica.com                                          cberg@ucare.org




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