Greater Value Portfolio Grantees 2022

Poor coordination during care transitions exposes patients to complications, distress, and costly readmissions. Due to language and cultural barriers, patients with limited English proficiency (LEP) face unique challenges during care transitions. In the United States, 25.5 million people speak English less than “very well.” Despite regulations mandating interpreter services, implementation gaps routinely lead to the failure of accessible, linguistically, culturally sensitive, high-value care for this growing population. They developed the Pharmacy Integrated Transitions (PIT) Program to improve coordination during healthcare transitions and launched a randomized trial to test the impact. Given that clinical outcomes and patient experience are worse for patients with LEP, this proposal aims to expand the current research to incorporate the narrative voice of Spanish-speaking patients and focus on the transition failures that drive disparate outcomes.

UW Medicine includes a hospital system (cancer, trauma, community, and quaternary care) with over 58,000 admissions yearly and a unique post-acute care strategy that includes collaboration with independent skilled nursing facilities (SNFs)with established data-sharing agreements and quality improvement initiatives. They will disseminate findings through publications, community, and national forums.

Significant racial and ethnic disparities in adverse maternal and newborn outcomes exist in the United States, and these disparities are not fully explained by clinical factors. Half of the childbirths in the U.S. are covered by commercial insurance, and out-of-pocket spending on maternity services for patients in these plans is high and rising, which can lead to forgone high-value care, especially for low-income and minority patients. They will partner with Blue Cross Blue Shield of Massachusetts (BCBS MA), a large non-profit health insurance carrier that covers 2.8 million lives across the US annually, to describe racial/ethnic differences in out-of-pocket spending for high-value prenatal care. They will evaluate the extent that utilization of high-value prenatal care explains racial/ethnic inequities in adverse maternal and newborn outcomes and how this contribution is altered by the structure of benefit design and other patient factors.

High-value care for pregnant people will be measured in terms of guideline-concordant and other prenatal care services that pregnant people need to reduce adverse maternal and newborn outcomes. The project addresses the potential that lowering cost-sharing barriers to these services can reduce disparities in maternal and newborn health. They will design and prepare to pilot an intervention targeting the reduction of racial/ethnic inequities in maternity care in the BCBS MA population. Dissemination of this work will also guide other health plans, employers, and policymakers in designing and targeting benefit design interventions to reduce racial/ethnic inequities and thereby improve the value of care.