California:
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Colorado:
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  • Special attention to tribes, homeless, children/youth.

Connecticut:
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  • Plan states that eliminating disparities is a priority in every aspect of the Plan.
  • Strong existing culture to fight disparities. (p. 51-52)
  • Establish an Equity and Access Council to develop metrics/analytics to guard against under-service.

Delaware:
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  • No mention, all sub-populations defined by age or medical condition.

Hawaii:
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  • Plan expresses a 4th objective to the “Triple Aim (+1)”: to reduce health disparities.

Idaho:
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  • 2 of Idaho’s 5 tribes gave input, focusing on behavioral health and specialty coordination needs.

Illinois:
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  • Key goal #2 of the Plan is to assure needed services and supports for people with special needs: mental illness, homeless, old and frail, justice-system involved, HIV/AIDS, intellectually or developmentally disabled. Primary care providers and specialists roles, composition of medical homes, care teams, Community Health Workers (CHWs) will all be redefined to care for special needs people.

Iowa:
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  • There are plans to specifically address the needs of the children, and the planned disparities in the future as a result of the demographics of the Iowa population changing from increased needs of the aging population, variance in the racial make-up. Identifies the need for supports for children diagnosed with serious emotional disturbance (SED) being greater in the African American Population.

Maryland:
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Michigan:
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  • Part of overarching aim-"reduced health disparities associated with race, ethnicity, income, geography or source of insurance.” (pg. 71)
  • "Provides Accountable Systems of Care and Community Health Innovation Region incentives to address environmental and social determinants of health.” (pg. 11)

New Hampshire:
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  • Focus was mainly on utilization of services amongst the target population of individuals in need of or at-risk for needing long term services and supports (LTSS).

New York:
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  • Plan states that “first critical step is to ensure that New Yorkers have access, without disparity, to quality health care.”
  • Prevention agenda also prioritizes addressing local health disparities.

Ohio:
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  • Ohio’s plan highlights the Preventive Health and Health Services Block Grant (PHHSBG), which is administered by Ohio Department of Health. PHHSBG’s goals are to: achieve health equity and eliminate health disparities by impacting social determinants of health; decrease premature death and disabilities due to chronic diseases and injuries by focusing on the leading preventable risk factors; support local health programs, systems, and policies to achieve healthy communities; and provide opportunities to address emerging health issues and gaps. (pg. 17)
  • The plan also notes - disparities are often due to differences in access to health care and other social services, availability of community resources (e.g., safe places to be active, healthy food options, etc.) and economic and educational opportunities. To address this significant burden, Ohio is developing a cross-cutting approach to improve health and reduce disease. Developed by more than 40 statewide partners, the plan will leverage activities ongoing through the state’s expansion of PCMH, adoption of HIT, integration of clinical services and population health and development of connections between community health and primary care. (pg. 9-10)

Pennsylvania:
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  • (Pg. 80) - The following disparity measures, for which Pennsylvania ranked 28th or below out of 50, indicate lack of good chronic care management:
    • hospital admissions for pediatric asthma (ranked 36th)
    • potentially avoidable hospitalizations from respiratory disease among adults (ranked 32nd);
    • potentially avoidable hospitalizations from complications of diabetes among adults (ranked 30th), and
    • percentage of adults who smoke (ranked 28th).
  • These and other indicators of health disparities, such as higher complications from poor chronic disease management in non-Hispanic black and Hispanic/Latino populations, will be directly addressed by the components of the Innovation Plan.
  • Access issues also noted – telemedicine as an approach to increase access. (pg. 107)

Rhode Island:
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  • Pg. 104-105 describes specific plans.
  • Establish interagency education and information programs that articulate impact of social determinants of health on different agencies. Information will be routed in improved data collection and research on the social determinants of health of Rhode Islanders, and will include robust reporting on the economic and social implications of the relevant social determinants of health to each department.
  • Creation of a Health Care Innovation Trust Fund.
  • Access through Accountable Care Organization (ACO)-like organizations, common care protocols/guidelines and incentives will improve access and outcomes.

Tennessee:
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  • Social factors such as income, educational attainment, and employment are significant determinants of health. Low incomes can result in unhealthy living conditions and can render care unaffordable. Tennesseans with low income may delay needed care or forgo preventive care, often increasing complications over the long term. Education levels impact economic opportunity, but also directly influence overall health and health literacy. In this sense, most of the activity of government and the private sector has an impact on health.
  • Improvements in health and health care can also have a positive impact on the economy. By reducing future health care costs, the initiative will reduce the pressure on the state budget that can then be invested into addressing these other determinants of health. Government resources saved through the initiative can be reallocated to support education, housing, and employment programs.

Texas:
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  • "Racial, ethnic, and urban-rural disparities identified as factors impacting health status” (pg. 44)
  • Healthy Babies Initiative focuses on provider education to reduce disparities in birth outcomes between racial and ethnic groups (pg.61)

Utah:
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Washington:
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  • The Innovation Plan recognizes health is a complex interplay of physical health; behavioral health; basic needs such as food, housing, education and employment; personal and family supports; welcoming communities; and quality of life—beginning at birth. Health and recovery services, without a strong foundation of equitable system supports and community services geared to sustain health, do not serve individuals as whole people. Additionally, without supports, such as payment models that incentivize outcomes, the system responsible for health cannot effectively deliver it. (pg. 14)
  • Improve health equity. Eliminating health and health care disparities will drive improved health outcomes and reduce costs. Broader coverage afforded through the Medicaid expansion and other health reforms is a necessary but insufficient step toward ensuring equitable access to care and other services. The strategies and infrastructure supports outlined in the Innovation Plan are directed to areas of particular inequity and anticipate resources devoted to monitoring access and outcomes for diverse individuals and populations across the state. (pg. 20)