Racial, income gaps in Minnesota medical care are closing, but modestly

Poor and minority patients in Minnesota are starting to receive better primary care, but they continue to have worse overall health outcomes and more difficulty managing chronic illnesses such as diabetes.

In a sign of progress against the state's longstanding health disparities, a new report shows that Minnesota clinics are doing a better job of screening low-income and minority adults for colon cancer and checking minority teenagers for depression — two of the medical indicators tracked in the annual review.

Timely colon cancer screenings for black adults increased from 56.4% of patients in 2014 to 58.6% last year, a modest rise but one that still represented progress in a minority group with a higher death rate from that form of cancer. Clinics showed particular progress with the Somali-speaking population. For them, screenings increased from 20.8% to 32.2%, according to the report, which was released Wednesday morning by the nonprofit MN Community Measurement.

"Anything we can do to close those gaps is a good thing," said Julie Sonier, president of MN Community Measurement, which uses clinic and insurance claim data to compile reports on quality of care and clinic results.

The degree of improvement, however, varied widely from one clinic to another. The Family Practice Medical Center in Willmar conducted recommended colon cancer screenings for 75.2% of white patients, but for only 13.3% of black patients.

Stillwater Medical Group by comparison had above average screening rates for black and white patients, 73.8% and 74% respectively. And its screening rate for Hispanics, 80%, was best in the state.

The screening disparity in Willmar was partly due to the fact that only 3% of its patients are black, said clinic administrator Stacey Zondervan. One black patient declining the procedure can change the clinic's rate substantially.

Zondervan said all patients are offered screenings at the appropriate time — often at age 50 for people without family cancer histories — but she said the results suggest the clinic needs to do better.

"I don't think that we've found that reliably effective way to communicate the importance of colonoscopies across all races and across all populations," she said.

The latest report shows how the public reporting of clinic scores can cause change in medical care, Sonier said. The share of teens screened for depression, for example, has jumped roughly 40 percentage points since her organization started tracking clinics on that measure three years ago. The rate in black teens increased from 37.6% in 2015 to 79.8% last year.

Fairview Health Services' teen depression screening rate was actually higher in black patients, 86.3%, than white patients, 74.3%.

One strategy for boosting those results is empowering all caregivers — from primary care doctors to cardiologists to urgent care clinicians — to check patient records and to notify patients when they are due for screenings or other recommended forms of care, said Valerie Overton, a Fairview vice president.

"If you can't present their health opportunities to them in that moment, you might not be able to get them back in," Overton said.

Overall, the report showed a closing of racial disparities on "process" measures — whether or not doctors ordered appropriate tests or procedures on schedule. Racial disparities did not improve in "outcome" measures, such as the actual health of diabetic patients.

The report found an 11 percentage point gap between blacks and the Minnesota state average for optimal management of diabetes — which is measured by blood pressure, blood sugar levels, medication and tobacco usage.

To close that gap, clinics would need to get another 2,403 black diabetes patients to optimal health.

The report did show some progress in closing disparities in health outcomes for low-income patients who receive Medicaid health benefits through the Minnesota Health Care Programs (MHCP).

The rates of low-income patients with optimal asthma and diabetes scores are catching up with the overall state rates, which is significant because management of those diseases can be challenging for poorer patients who struggle to afford medicine, healthy food and exercise options.

But the gaps remain. In 2018, 32.8% of MHCP patients with diabetes were optimally managing their diseases, compared to 47.7% of Minnesotans with private or other forms of insurance.

Jeremy Olson • 612-673-7744