Jun 14, 2022

Leveling disparities for some improves health care for all

ARC meets patients where they are to ensure access to resources

By Gemma A. Borja, PT, MS, MBA, CPHQ, Vice President, ARC Population Health and Clinical Quality and Dr. Anas Daghestani, ARC President, CEO and Medical Director, ARC Population Health and Clinical Quality

It's an uncomfortable reality. National data shows that individuals of a specific age, income, or cultural background often lag in improvements in chronic care management. Persistent roadblocks such as low income and access to technology, transportation, or affordable insurance can prevent patients from getting the healthcare services they need.

These disparities in healthcare access affect everyone. Overall population health suffers, and costs rise for all when access for some is limited. Patients who focus on long-term health management and actively engage in healthy lifestyle choices spend less time in the hospital and have fewer acute-care visits. Additionally, high-quality healthcare organizations that help patients engage with long-term health outcomes can more effectively allocate resources to focus on long-term conditions instead of reacting only to acute issues that are avoidable.

A holistic approach increases engagement and outcomes

ARC Population Health – now in its 13th year – is supporting ARC physicians and staff continuing to level disparities through a culture that meets patients where they are with the healthcare resources they need. This approach builds trust by providing healthcare options that reach patients in their language, with sensitivity to the cost of care, and at their level of digital comfort.

It’s a holistic approach to health care has seen and continues to see tremendous results.

ARC has significantly and consistently improved outcomes across key health metrics over the years that, taken together, measure our ability to engage patients and improve their overall health. These improvements impact their financial and mental well-being by enabling these patients to:

  • save money that might otherwise go to acute care and hospital stays or ER visits.
  • enjoy more time with friends and family.
  • develop in hobbies and pastimes.

Decreasing disparities in compliance across racial and ethnic lines

These metrics, just a few of the many tracked by ARC Population Health and Clinical Quality, are critical indicators for larger, chronic health issues. We focus on metrics that have the greatest impact on overall quality of life and reach out to patients in a variety of ways to increase engagement.

  • Blood pressure. As blood pressure is the most controllable risk factor for stroke and heart attacks, we focus heavily on reminders in our patient portal, ARC MyChart. Our nurse navigators also call to check in with our highest risk patients. ARC’s blood pressure control rate of 84.40%, which is in the top 10% nationwide, surpasses the Texas rate of 46.60%. Additionally, the ARC compliance rates are nearly equal rates across racial groups.
  • A1c levels. The presence of an elevated A1c indicates the presence of excessive sugar in the bloodstream, often tied to the level of diabetes control. Regular monitoring of A1c levels and checkups help keep patients aware of risks and encourages conversations with their care teams.
  • Diabetic eye exams. Diabetic retinopathy is the leading cause of blindness in all adults under the age of 75. It presents with no symptoms in early stages, but can be detected in five minutes with a painless in-clinic screening. In 2021, ARC saved the vision of 238 patients who would have lost their vision within 12 months. The IRIS (Intelligent Retinal Imaging System) screening, in a dozen different ARC labs, makes it easy for patients to get a screening at the time of their appointment. We started with three locations in 2016, growing to 12 locations with plans to continue to expand access to this sight-saving service. ARC’s screening rate is more than 12% higher than the Texas rate, with 12,842 patients living with diabetes who are up to date on their regular screening.
  • Cancer screenings. Since the colon cancer screening is less popular with patients, we employ many methods of communication and engagement including messaging through the online patient portal, text messaging, direct mail, and wider scale engagement and educational opportunities. We also offer multiple screening options to patients who are lower risk and overdue for a screening, while reminding them the primary goal is preventing cancer by detecting and removing polyps before they possibly turn into cancer. The secondary goal is early detection, when cancer is caught early, the five-year survival rate for colon cancer is over 90%. We remind patients that breast cancer represents 14.8% of all new cancer cases in the U.S. and survival rates are 98% when breast cancer is detected early. For cervical cancer, screening rates are comparable across races and ethnicities. Leveling disparities enables us to continue to equalize healthcare outcomes for all.

Feeling understood positively impacts outcomes

Our culture and the diversity of our physicians and staff, matching the diversity of our community, allows us to naturally be better positioned to support our patients and communities.

We have succeeded in diminishing disparities with teams of doctors, nurses, and staff with different racial, ethnic, and cultural backgrounds. This approach creates a welcoming environment where patients can see themselves in the people who care for them in our clinics.

These healthcare professionals take extra steps to overcome obstacles between our patients and their care. Our nurse navigators see themselves as patient advocates and account for each patient’s mobility, home and work setting, and family involvement when delivering health care and offering solutions. They are integral to the success of health outcomes. When we look at how the nurse navigators succeed, in partnership with physicians and clinic staff, there are six key areas.

  1. Blend medical and personal goals
    When pursuing a provider's health goal for a patient, like an A1C goal for diabetes, our nurse navigators connect with the patient’s personal goals like diet management and exercise. They work with the patient to create a path to achieving both. That pathway might include support from family, friends, or neighbors to help the patient achieve the combined goals.
  2. Partner with the community
    Our nurse navigators frequently work with community members and organizations to connect patients with resources and services. For example, a patient outside the Austin area recently needed transportation assistance to receive daily radiation treatments. When the nurse found out there were no city bus services in the area, the ARC team reached out to local churches, the Lions Club, and four other community resources to help the patient find daily rides to an ARC location.

    Our nurses also work closely with patients to determine if they have the right foods to support their treatment's nutrition or diet requirements, such as diabetes management. If they don’t have proper nutrition, the nurse will connect them with the appropriate medical and community resources.
  3. Break down cultural barriers
    Cultural or religious restrictions can interfere with treatment plans. The fasting observance of Ramadan, for example, can prevent patients from taking medicines like insulin that need to be administered during mealtimes.

    When this happens, our nurse navigators will work with patients and providers to make adjustments that allow them to adhere to their medication routines and still honor religious and cultural observances.
  4. Simplify communications Chronic care management can be overly detailed and overwhelming to patients living with a disease. We adjust the conversation to meet the patient’s understanding and communication preferences.

    For example, our nurse navigators often bring patients in for meetings to go over their treatments, medicines, and schedules. We keep the conversation at a basic level, utilizing images, diagrams, and infographics to help them understand what they need to do to support their treatment. We may explain the different types of carbohydrates and the nutritional differences between an orange vs. a potato. They use that information to develop a meal plan they can easily follow.

    Many of our nurse navigators speak two or more languages. When a language barrier occurs that we can’t overcome, we’ll bring in outside sources to provide translations.
  5. Demystify insurance
    It's difficult for all of us and for most people to fully understand all the complexities of insurance requirements. But our nurse navigators work directly with patients to help demystify insurance as much as possible. For example, we partner with the experts to facilitate information sessions with our Medicare eligible patients to help them understand Medicare coverage and prescription plans.

    We help them navigate what is in and out of network for insurance plans. And we provide them with questions to ask their insurance providers about coverage for upcoming treatments and medications. One ARC patient recently shared that we helped his wife save up to $20,000 on her treatments at MD Anderson by asking their insurance provider the right questions.
  6. Access and assistance with medical devices
    It’s not unusual for insurance providers to exclude the cost of at-home medical devices like those used to monitor and support blood pressure and diabetes management. Our nurse navigators educate patients about the importance of these devices and help them locate low-cost options on the market.

Harnessing technology patients use

For patients who might have complex medication schedules and reoccurring appointments, our nurse navigators will help them set up alarms and reminders on their smartphones. They also work with patients to help them understand and interact with the ARC MyChart patient portal. Currently, about 80% of all ARC patients use MyChart. We see a strong correlation of MyChart use with improved access to care and thus being more up to date on your prevention and overall health needs.

ARC Population Health works very closely with ARC physicians and clinical staff, investing time and effort to build trust with each patient. Working at that individual level helps us level disparities in health outcomes across patient groups and demographics. Through Population Health, ARC physicians and clinic staff, ARC has always been a partner of the Austin community and continue to reflect the people and cultures around us.