Minnesota and Ohio: Advancing Health Equity through Delivery System Reform

By Carrie Hanlon

August 2012

Racial and ethnic minorities disproportionately experience chronic disease, often receive suboptimal quality care and therefore can benefit most from delivery reform initiatives aiming to improve quality and care coordination, particularly for the chronically ill.  Through a variety of provisions, the Affordable Care Act (ACA) facilitates state and federal action to advance health equity for racial and ethnic minorities. Minnesota and Ohio participated in a recent NASHP learning collaborative, and their efforts demonstrate four ways states can incorporate health equity into delivery reform initiatives to ensure high-quality, equitable care for all.

  1. Encourage health and medical home providers to serve diverse populations.  Ohio expanded its existing state patient-centered medical home pilot program to six additional practices that were selected based on their serving primarily racial and ethnic minorities and underserved communities. The belief is that this effort to target populations who bear a disproportionate burden of diseases and poor health outcomes will provide faster return on investment through improved outcomes and cost savings.
  2. Educate health home and medical home providers about health equity.  Minnesota developed and hosted a health equity educational session for health care home providers that featured best practices in providing culturally competent care and covered topics such as race/ethnicity/language data collection and use, and provision of patient- and family-centered care for diverse populations.  It is not a one-time event.
  3. Standardize race/ethnicity/language (REL) data collection and share disparities data with decision makers. A data workgroup in Minnesota is creating a consensus recommendation on the standardized collection of REL data for state health reform activities.  The workgroup’s recommendations will be presented to both the Governor’s Task Force on Health Reform and the Health Insurance Exchange Task Force.  The latter recently committed to making each of its policy recommendations only after it considers the impact on health disparities.  The decision was a direct result of health equity data and policy options presented during a January 2012 meeting devoted to the topic.
  4. Encourage or require managed care organizations (MCOs) to address health equity. Ohio state officials proposed MCO requirements for consideration by state Medicaid.  The proposed language would establish a new Medicaid Health Equity Workgroup to regularly review contracts, create and implement baseline data measures, and link MCOs to organizations that can help them implement effective solutions to decrease health disparities.  The draft language also requires MCOs to:


  • Systematically collect self-identified REL patient data;
  • Better identify and manage groups known to experience health care disparities;
  • Use culturally appropriate materials; and
  • Participate in the aforementioned Medicaid Health Equity Workgroup.

At the federal level, ACA provides a unique platform to catalyze state efforts to advance health equity in delivery reform. Two recent federal opportunities made possible by ACA can help states address disparities in quality of care, particularly in Medicaid.

  • The Center for Medicare and Medicaid Innovation’s new State Innovation Models (SIM) initiative will provide funding for up to 30 states to test payment and service delivery models within the context of larger health system transformation.  The SIM funding opportunity announcement encourages state applicants “to include care models and interventions that aim to reduce health disparities and address the social, economic, and behavioral determinants of health.”
  • The Centers for Medicare and Medicaid Services (CMS) is awarding Adult Medicaid Quality Grants to help states test and standardize collection and reporting of an initial core set of adult quality measures and use these data to drive quality improvement.  States must begin testing their ability to evaluate disparities using at least two demographic categories, of which options include race/ethnicity and language.
  • Minnesota and Ohio are two of seven states that participated in NASHP’s Health Equity Learning Collaborative.  With funding from the Aetna Foundation, the Collaborative also supported teams of officials from Arkansas, Connecticut, Hawaii, New Mexico and Virginia in their efforts to simultaneously advance health equity and implement health reform.


As the recent NASHP report, State Policymakers’ Guide for Advancing Health Equity through Health Reform Implementation, describes, states continuing to move forward with delivery reform as part of ACA and statewide initiatives can look to Minnesota, Ohio and the other Health Equity Learning Collaborative states for strategies to advance health equity.


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