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CCO Data Debunks Myth of Immigrant Burden to Medicaid

The Oregon Health Authority released baseline demographic health data for the Oregon Health population that will help the state provide more equitable care in CCOs. Deep inequities are revealed among blacks and American Indians, while low immunization rates are most pronounced among white kids.
November 20, 2013
New data released this month shows that Latinos on the Oregon Health Plan are much less likely to use the emergency room or outpatient health services than other residents, disproving a myth that a recent wave of immigration from Latin America has burdened the state’s Medicaid program.   Emergency use by Latinos was 38 percent lower than non-Hispanic white Medicaid clients while outpatient visits were 3 percent lower, according to data reported in 2011, before the launch of the state’s coordinated care organizations to deliver the Oregon Health Plan. Latinos’ outpatient visits were the lowest of any ethnic group at 295 per 1,000 member months – indicating a potential separate problem: a reluctance to seek any healthcare services.    Outpatient visits include office visits, nursing home care, mental health counseling and urgent care.   “Some of the results are likely due to the Latino Paradox which tells us that First Generation Latino Immigrants who come to the US actually have better or equal health outcomes to whites,” said Alberto Moreno, the director of the Oregon Latino Health Coalition.    Moreno added that the low numbers for the state’s largest minority group also “may be evidence that our healthcare systems are not as culturally and linguistically competent as we need them to be. This suggests a need for more bilingual, bicultural staff and more welcoming clinic settings.”   A key legislative victory for health equity advocates this past session was a law that allows the state health boards to mandate cultural competency training for professionals wishing to stay licensed. Moreno’s organization lobbied for the law, along with the Urban League and Oregon Action.   “It was an important victory,” said Ty Schwoeffermann of the Urban League. “There is a commitment from the healthcare professions to become more responsive and culturally relevant. Our diversity as a state is increasing so our healthcare system will need to be more responsive.”   While each race or ethnicity had challenges, the greatest disparities in health outcomes fell on the African-Americans and American Indians who receive care under the Oregon Health Plan.   African-Americans used the emergency department 32 percent more often than the state average, while making use of outpatient services at a rate 9 percent lower than the state average – the opposite kind of use as envisioned by CCOs, which coordinate care through general practitioners.   Schwoeffermann said the Urban League trained 28 community health workers this summer to assist black Oregonians, both African immigrants and members of the established African-American community. The league plans to train another 25 workers this winter with the goal of closing the health disparity gap for African-Americans.   The demographic data was included in an Oregon Health Authority report released earlier this month at the Oregon Health Policy Board meeting which showed marked improvement in the way CCOs have delivered care to the state’s most vulnerable residents.   New data reported from the first half of this year was not broken down by ethnicity, but Tina Edlund, chief of policy at the health authority, said that the next report in February will include data broken down by race that will show how well the state’s CCOs have reduced racial and ethnic disparities in healthcare for the Medicaid population.   “It’s important to address these disparities and move the needle for everyone,” Edlund told The Lund Report. “[CCOs will] be able to look at geographic differences. They’ll be able to design cultural-specific solutions.”   American Indians had better access to primary care than the state average, but were also heavy users of emergency departments. Native Americans were near the bottom of most of the metrics, including diabetes management, well-child visits and psychiatric follow-up care.   Asian-Americans had good numbers when it came to preventive care, but showed low use of either outpatient or emergency services.   Tricia Tillman, director of the state Office on Health Equity & Inclusion, cautioned against drawing too much from the preliminary baseline data, noting that future data will be able to show trends over time. She did say that such disparities were unsurprising, however, and lined up with other health equity reports.   “African-Americans and native Americans have been systematically disconnected from their indigenous culture, from their indigenous ways, from their traditional diet,” Tillman said.    “We’re seeing the consequences of a broader system of inequity playing out.”   Both blacks and American Indians represent 2 percent of the general Oregon population, while the state is 12 percent Latino. However, blacks and Latinos are over-represented in the Medicaid population with 22 percent of Oregon Health Plan members Hispanic, and 4 percent of the population is African-American.   White Oregonians were not immune from negative departures from the state average. While racial minorities had average or better rates of vaccination, the rates for white children were paltry – with only 60 percent of 2-year-olds receiving their recommended shots and only 43 percent of white 7th graders.   Oregon has the lowest rate of kindergarten vaccination in the country, leading the Legislature this summer to pass a law tightening the ability of parents to opt-out of vaccinations for non- medical reasons.   Chris can be reached at [email protected].