Once race and ethnicity data have been collected, health care professionals can link this information with performance measures to pinpoint disparities in patient care. With support from the Fund, the Center for Health Care Strategies has been working with 12 Medicaid managed care plans from across the country to develop strategies for identifying and addressing disparities.⁽⁴⁾ These plans have sought to improve care in a range of areas, including teenage pregnancy, childhood asthma, diabetes care for Native Americans, prenatal care, and child immunizations. Preliminary results show improvements in both the processes and outcomes of health care, as well as some reduction in disparities.

In a Fund report exploring policy options to promote collection of race and ethnicity data, Sidney D. Watson, J.D., a professor at the Saint Louis University School of Law, argues that incorporating measures of equity into existing quality reporting does not require legislative action.⁽⁵⁾ According to Watson, Medicaid and Medicare managed care plans, the Centers for Medicare and Medicaid Services (CMS), and states already have the necessary regulatory authority to mandate that health care organizations report performance data on measures of equity—to demonstrate that they provide the same quality of care to all patients, regardless of race or ethnicity. CMS could, for example, use financial incentives to encourage equity performance measurement, just as it now uses incentives to encourage hospitals to report overall performance data. Private accreditation bodies could include equity performance measurement as part of their voluntary accreditation processes.

Although many studies have documented the underuse of appropriate care among minority populations, the underlying reasons are not well understood. An earlier Fund grant to the Mount Sinai School of Medicine, led by Mark Chassin, M.D., investigated this phenomenon by focusing on black and Hispanic hospital patients in New York's East and Central Harlem. By listening to patients and examining patterns of service use, the project investigators were able to measure underuse, pinpoint some of its causes, and develop a patient-centered approach to treatment emphasizing health promotion and patient self-management. Two of the hospitals involved with the project were able to reduce patients' hospitalizations and generate savings. As a result, they secured enhanced Medicaid payment rates from New York State for treating patients in the new program.