Health Inequity Data Can Inform Case Managers About Challenges Some Clients Face

MaryBeth Kurland, CAE, CEO of CCMC

This blog was originally posted to https://allnurses.com/.

Case managers are likely well-acquainted with the impact of health inequities on their work. The United States population is diverse, and recent research showcases disparities in access to health care and health outcomes. Socioeconomic factors affect clients’ ability to manage their health. As experts in securing health and social services, case managers and disability management specialists understand their clients’ needs and how to help them access assistance, even when doing so proves difficult.

The Commission for Case Manager Certification celebrates differences across demographics and characteristics that make each person unique. Case managers and disability management specialists who understand the diverse array of clients they serve strengthen their support and improve outcomes. People in historically marginalized racial and ethnic groups face inequities in health outcomes, access to primary care, behavioral health care, and dental care. Knowledge of this evidence can help case managers and disability management specialists better advocate for and serve their clients.

We value diversity in our case manager and disability management specialist workforce, as it enables clients to work with experts who better understand their circumstances. For instance, a Latina case manager might be a strong match for a client new to this country, who needs Spanish language translation assistance and help understanding American culture. A diverse workforce can also help address health disparities, particularly when practitioners share common cultural experiences with clients by keeping that perspective in mind.

For example, case managers are distinctly positioned to address inequities by ensuring clients get access to needed care. Health equity data—which showcases specific, measurable differences in health outcomes—improves care by offering detailed information about these inequities. Case managers can advocate for clients they see encountering such inequities in their daily work.

To further inform the case management and disability management workforce, we recently hosted a webinar with the Commonwealth Fund, “Health Equity: Access-to-care data helps us understand racial and ethnic disparities.” The Commonwealth Fund promotes improved healthcare access for all and recently released a scorecard on health equity: “Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance.”[5] The webinar explores important findings from this scorecard and provides insights into what they mean for case managers.

Among these findings:

  • In each U.S. state, health care systems do not adequately address the needs of people of color, while white residents in nearly every state experience stronger health care system performance[6].
  • Black and Asian American, Hawaiian, and Pacific Islander (AANHPI) people tend to face poorer health outcomes, including earlier deaths from preventable diseases and higher maternal mortality rates, as well as less insurance access and lower use of primary care.[7]
  • Case managers can help address disparities by encouraging risk-reduction measures and helping clients navigate the health system while understanding barriers to access.

The Commonwealth Fund scorecard also examines the following dimensions of these inequities: affordable access, health care quality and use, as well as health outcomes.

Affordable access

Economic inequities and the racial wealth gap also drive health care disparities. Affordable health care access is a crucial factor determined by whether clients have insurance coverage and a regular health care provider. Additionally, these economic considerations also may include whether clients avoid seeking care due to cost concerns and large portions of their income being potentially spent on health expenses.

The health equity scorecard uncovered that white populations have more access to care than people of all other races. Although the expansion of the Affordable Care Act has improved coverage gaps, uninsured rates remain high among certain groups. Available insurance coverage contributes heavily to access to care by reducing financial risk.

In addition, predominantly Black or Latinx neighborhoods are less likely to have primary care providers, and variations in providers’ acceptance of different insurance options can create additional barriers to affordable care access.

Health care quality and use

It’s essential to determine whether clients receive high-quality care and necessary services to prevent future health problems and manage chronic conditions, as well as how often they use costly settings such as emergency departments when primary care would suffice.

Black, Latinx/Hispanic and AANHPI people have comparatively lower use of primary care than white people, who receive better overall care. 7 Primary care access improves health outcomes, and thus greater access and quality for these groups should be a priority.

Recommending the right service, care and provider matters. For instance, cancer is often diagnosed later for Black adults, but regardless of the diagnosis stage, they experience lower five-year survival rates than do white adults, indicating critical inequities in quality of care.[8]

Health outcomes

Health outcomes gauge earlier deaths from treatable and/or preventable causes, as well as the prevalence of risky behaviors or conditions (e.g., smoking or obesity).

Health outcomes are also measured by mortality rates and prevalence of health problems. In most states, they are worse for Black and AANHPI people than white and Latinx/Hispanic populations.[9]

In most states, white people are less likely to die of preventable causes than Black people. The Commonwealth Fund’s scorecard dives into a metric called mortality amenable to health care, referring to deaths prior to age 75 due to treatable causes such as diabetes. This rate is higher among Black people (and sometimes even double) the overall rate among U.S. adults. This can be attributed to lower treatment rates and various missed points of potential intervention throughout the care process, including differences in prescribed medications and procedures.

Patient journeys: How case managers can help navigate

This data may seem disheartening, but case managers and disability management specilists can play a fundamental role in improving care access and outcomes. For example, many obstacles in the U.S. health care system are administrative—selecting insurance, finding the right provider who takes one’s insurance, and understanding prior authorizations. Case managers and disability management specialists can help clients surpass these hurdles while keeping potential disparities in mind.

Case managers and disability management specialists must recognize their own implicit biases that may affect clients. This requires thinking through and acknowledging any underlying associations one’s mind may make relating to a client’s age, appearance, disability, ethnicity, gender identity, location, nationality, professional level, race, religion, sexual orientation, and/or socioeconomic status. Everyone has implicit biases, and fostering awareness of potentially harmful ones makes all the difference. Challenging personal thought processes can bolster client support, foster empathy and improve outcomes.

It’s crucial to remember that external social determinants of health may limit clients’ access to transportation, healthy food, social services, and language translation. Case managers and disability management specialists are uniquely positioned to recognize and address how these factors coincide and to navigate the system to benefit each individual client. For example, case managers can keep in mind external hurdles while connecting clients with care providers, ensuring access to preventive services, and helping them overcome administrative barriers.

I’d like to take a moment to commend the case managers and disability management specialists who regularly confront health inequities in their work. I encourage you to learn more about his important data from the Commonwealth Fund to further inform and propel efforts to ensure everyone gets the care they need. To view the free webinar, click here.

 

[1] David C. Radley et al., Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance (Commonwealth Fund, Nov. 2021). https://doi.org/10.26099/ggmq-mm33

[2] Arnett MJ, Thorpe RJ Jr, Gaskin DJ, Bowie JV, LaVeist TA. Race, Medical Mistrust, and Segregation in Primary Care as Usual Source of Care: Findings from the Exploring Health Disparities in Integrated Communities Study. J Urban Health. 2016 Jun;93(3):456-67. doi: 10.1007/s11524-016-0054-9. PMID: 27193595; PMCID: PMC4899337.

[3]Behavioral Health Equity Report 2021. Substance Abuse and Mental Health Services Administration, 2021.

[4] Han C. Oral health disparities: Racial, language and nativity effects. SSM Popul Health. 2019 Jun 21;8:100436. doi: 10.1016/j.ssmph.2019.100436. Erratum in: SSM Popul Health. 2020 Dec 10;12:100711. PMID: 31372488; PMCID: PMC6658987.

[5] David C. Radley et al., Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance (Commonwealth Fund, Nov. 2021). https://doi.org/10.26099/ggmq-mm33

[6] David C. Radley et al., Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance (Commonwealth Fund, Nov. 2021). https://doi.org/10.26099/ggmq-mm33

7 David C. Radley et al., Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance (Commonwealth Fund, Nov. 2021). https://doi.org/10.26099/ggmq-mm33

[7] David C. Radley et al., Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance (Commonwealth Fund, Nov. 2021). https://doi.org/10.26099/ggmq-mm33

7 David C. Radley et al., Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance (Commonwealth Fund, Nov. 2021). https://doi.org/10.26099/ggmq-mm33

[8] David C. Radley et al., Achieving Racial and Ethnic Equity in U.S. Health Care: A Scorecard of State Performance (Commonwealth Fund, Nov. 2021). https://doi.org/10.26099/ggmq-mm33