Challenge

Hispanic patients at Fairfax County, Virginia’s, safety-net clinics are more likely to receive “high performance” care for cervical cancer screening, diabetes control, and hypertension control than non-Hispanic patients. Fairfax County and its clinical partners—originally Molina Healthcare and now Inova Health System—wanted to extend the same quality of care to the diverse, multilingual non-Hispanic population.

Partners:

• George Mason University Center for Health Policy Research and Ethics (Investigator)
• Inova Health System (Provider/clinic operator from July 2016 to present)
• Fairfax County Health Department/Community Health Care Network (Payer/health care network) 
• Molina Healthcare Inc.* (Provider/clinic operator through June 30, 2016)

Setting

Fairfax County, in Northern Virginia, runs a Community Health Care Network (CHCN) of clinics for the 8% of its population (about 100,000 people) who are uninsured. Due to the high population of Spanish-speaking patients, Community Health Care Network (CHCN) clinics have long hired Spanish language translators.

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Patient participants

Hispanic and non-Hispanic CHCN patients with diabetes or hypertension, or those who, otherwise, were good candidates for cervical cancer screening. 

Intervention team

Each clinic intervention team included: primary care and specialist physicians; nurses; one county public health nurse liaison, who linked patients to WIC, vision clinic, speech and hearing, or other Health Department services; one or two county referral specialists, who connected patients to needed specialty care (i.e., cardiology, physical therapy, etc.) and community resources (i.e., food banks, housing assistance, etc.), and human service enrollment staff members responsible for CHCN intake who also could process an application for Medicaid or food stamps.

“The staff got into RCA big time. They learned things from each other. The conversation during the RCA revealed how closely all of the staff members watch over and care for their patients.”

Len M. Nichols, PhD
Project Director

Payment incentive under Molina

Molina, the first clinic operator, awarded all members of the care team a bonus—a percentage of each staff member’s base pay—for meeting quality care and productivity target measures. Molina also incorporated relative value units (RVUs) in calculating the payment incentive. RVUs assign value to a specific procedure or activity. Activities that promoted disparities reduction for target conditions—for example, identifying a patient in need of cervical cancer screening and getting her screened the same day—were assigned a higher value.

The county and Molina agreed on a maximum budget each year. Molina decided how and where to spend the money in running the clinics and paying care teams. The payment incentive was incorporated into Molina’s clinical care team compensation scheme and was budget-neutral.

Tools for Success

Payment incentive

The clinical team earns a bonus based on quality care, productivity, and disparities reduction measures.

Root cause analysis (RCA)

All clinic staff members collaborated to discuss and pinpoint potential causes of observed disparities before patient focus groups explored the issues raised. For example, the clinics have long hired Spanish language translators, but translators for other languages were harder to access.

Performance data

Patient data were stratified by ethnic group (using electronic health records), allowing for disparities reduction analysis.

Patient surveys

Pre- and post-intervention surveys detailed patient experience and behavioral/health self-management.

Other patient resources

Co-pay coupons were available to patients who attended certain follow-up visits.

Finding Answers: Solving Disparities Through Payment and Delivery System Reform was a national program funded by the Robert Wood Johnson Foundation with technical assistance and direction provided by the University of Chicago. Finding Answers was created to discover and disseminate practical ways to achieve health equity and was focused on discovering how healthcare payment and delivery systems can be redesigned to reduce and eliminate health care disparities. Its work included three pilot projects involving health systems and payers partnering to improve health equity. To read more about Finding Answers, please click here.