Health Share Aims for More ‘Authentic’ Community Engagement

Health Share, serving 229,000 people in three counties or about 13 percent of the metropolitan Portland population, has outgrown its original dashboard data reporting tool – just a giant Excel monthly summary of members’ healthcare use, costs and demographics. Now Oregon’s largest coordinated care organization (CCO) told its community advisory council new data tools will peer beyond claims data to look more closely at communities facing health and healthcare disparities to find the story behind the raw information.

Since Health Share formed its data analytics team a year ago, Sandra Clark, project director for community health strategies, says “we’re asking a lot more questions than providing answers.”

For example, Health Share has beat its’ required benchmark overall on childhood developmental screenings, an important prevention opportunity, but falls below targets screening Asian-Pacific Islander and African-American children. Looking through the non-English language lens, Health Share does great screening Spanish-speaking children but less so with Burmese, Somali, Vietnamese, Russian and Chinese language speakers.

“What’s the story? Are they not in primary care? Or, if they are in primary care, are they not being screened? Is the screening culturally appropriate in the first place? What’s the larger goal here?” Clark asked.

Health Share knows 38,000 members speak a language other than English but “we only know the preferred language of two-thirds of our members,” Clark said. Not everyone chooses to disclose language preferences when they enroll, and “not all information comes along when people re-enroll” if they lost eligibility for Medicaid. Health Share’s working with the Oregon Health Authority to close that gap but needs a deeper dive to understand its members’ language needs.

Demographic data shows that 46 percent of the African Americans in the 97233 zip code have a Health Share card, and 30 percent in another zip code are under the age of five. Clark said the CCO is on a path to “engage communities authentically” to use that level of geographic data.

One tool Health Share showcased is an OHA grant to fund three Photo Voice projects similar to a recent Northwest Family Services and Kaiser Permanente Photo Voice project at Kaiser’s Mt. Scott clinic where 22 primarily Spanish-speaking community members took photos and shared their thoughts on what they celebrated about their health and the barriers.

Photos of cars, cigarettes, sugary drinks and even a dirty microwave oven represented barriers. Photos of clean water, time with families, girls in sports, reading and a dog to walk represented health. An 11-year-old boy took a photo of a bullet-damaged stop sign to show why his parents think his neighborhood is too violent for him to go outside to play.

Kaiser’s Allyson Kohl said the Mt. Scott-area photos – along with extended captions from each photographer explaining the photo in their own words —were shown to local doctors, nurses, front-desk workers and Kaiser managers, an “eye opening” process but the project didn’t include a strategy for addressing barriers.

A similar Photo Voice project at Central City Concern was powerful but “health plans can’t address the violence” or some of the other issues depicted, according to Gary Cobb, council member.

Public testimony focused on clinical and logistical difficulties such as wheelchairs not always transported with patients in ambulances, creating expensive and unnecessary extra days of hospital stays until the wheelchair and patient can be reunited.

Jan can be reached at [email protected].