Inspired to reduce barriers faced by minorities when trying to access healthcare and to navigate the health care system, Dr. Milagros Abreu founded the Latino Health Insurance Program, Inc. (LHIP) in East Boston in 2006. In Massachusetts, the proportion of Latino residents who report having diabetes is 14.2% compared to 6.5% for the general population. Age-standardized death rates (per 100,000 people) from 2003-2005, for heart disease and diabetes were higher among residents from towns and cities with a high concentration of minorities such as the cities LHIP serves. The population served by LHIP is 95% low-income and speaks Spanish or Portuguese as a first language.
Targeted at a population with a low rate of health insurance enrollment, LHIP’s aimed to improve the quality of medical care and coverage for minorities, as well as to provide information that is culturally and linguistically sensitive and appropriate about how to manage their chronic disease conditions. Milagros prioritized increasing access to medical care and food for minority residents, connecting them to medical facilities, and improving health literacy, while reducing medical cost.
As part of LHIP’s efforts to address the social determinants of health and the health care needs of Hispanic and Latino patients with diabetes, LHIP created a Diabetes Prevention Clinic. Milagros’ approach was to start by looking at how people receive health care information, how they are engaged in their communities and what works in terms of preventing or managing their chronic conditions. The clinic provides care management and care coordination to individuals with diabetes or prediabetes by connecting them to resources available within LHIP or offered by community partners in order to reduce complications from their diseases and the incidence of unnecessary emergency room visits and hospital admissions. LHIP provides culturally and linguistically appropriate mental health services and patient navigation assistance and referrals for housing, nutrition and transportation.
Focusing on the needs of the community, LHIP’s systems changing approach to care coordination and chronic disease prevention and management has ensured that people who were not receiving any health care and did not even understand why they needed it are being engaged and empowered to be more proactive in navigating the health care system.
LHIP’s cost containment model is reducing health care cost by mitigating risk factors through care coordination and chronic disease self-management. The combined cost of care coordination and chronic care management is $125 or $187,500 for 1500 patients vs. $30,050,000 for the same number of patients that are treated in acute inpatient care or readmitted for 30 days.
Through its approach to healthcare delivery, LHIP’s new health care workforce model is designed to reach, educate and care for the hardest to reach minorities in the community. LHIP has built partnerships with boards of health, faith based organizations and a wide network of community-based organizations throughout the Commonwealth of Massachusetts and is addressing the social determinants of health for high risk populations.