A case study of the 1115 waiver using population health informatics to address disparities

Amy M Sitapati; Barbara Berkovich; April Moreno Arellano; Angela Scioscia; Lawrence S Friedman; Marlene Millen; Patricia Maysent; Ming Tai-Seale; Christopher A Longhurst

doi:10.1093/jamiaopen/ooaa019

A case study of the 1115 waiver using population health informatics to address disparities

JAMIA Open. 2020 Jun 28;3(2):178-184. doi: 10.1093/jamiaopen/ooaa019. eCollection 2020 Jul.

Authors

Amy M Sitapati¹, Barbara Berkovich², April Moreno Arellano³, Angela Scioscia⁴, Lawrence S Friedman⁵, Marlene Millen⁶, Patricia Maysent⁷, Ming Tai-Seale⁸, Christopher A Longhurst^{9

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Affiliations

¹ Division of General Internal Medicine and Division of Biomedical Informatics, Department of Medicine, University of California San Diego Health, San Diego, California, USA.
² Hahn School of Nursing, University of San Diego, San Diego, California, USA.
³ Department of Medicine, University of California San Diego, San Diego, California, USA.
⁴ Department of Obstetrics, Gynecology and Reproductive Science, University of California San Diego Health, San Diego, California, USA.
⁵ Department of Medicine and Pediatrics, University of California San Diego Health, San Diego, California, USA.
⁶ Division of General Internal Medicine and Division of Biomedical Informatics, Department of Medicine, Chief Medical Information Officer of Ambulatory and Affiliates, University of California San Diego, San Diego, California, USA.
⁷ University of California San Diego Health, San Diego, California, USA.
⁸ Department of Family Medicine and Public Health, and Information Services, University of California San Diego Health, San Diego, California, USA.
⁹ Department of Biomedical Informatics, University of California San Diego Health, San Diego, California, USA.
¹⁰ Department of Pediatrics, University of California San Diego Health, San Diego, California, USA.

Abstract

As participants in the California Medicaid 1115 waiver, the University of California San Diego Health (UCSDH) used population health informatics tools to address health disparities. This case study describes a modern application of health informatics to improve data capture, describe health disparities through demographic stratification, and drive reliable care through electronic medical record-based registries. We provide a details in our successful approach using (1) standardized collection of race, ethnicity, language, sexual orientation, and gender identity data, (2) stratification of 8 quality measures by demographic profile, and (3) improved quality performance through registries for wellness, social determinants of health, and chronic disease. A strong population health platform paired with executive support, physician leadership, education and training, and workflow redesign can improve the representation of diversity and drive reliable processes for care delivery that improve health equity.

Keywords: CMS 1115 waiver; clinical informatics; health IT; health disparities; population health.

Grants and funding

T15 LM011271/LM/NLM NIH HHS/United States