Tamiko Foster, MD, MPH


Corporate Medical Director, WellCare Health Plans, Tampa, FL

Dr. Tamiko Foster is the Corporate Medical Director at WellCare Health Plans. Previously she was Chief Medical Officer and Director of Quality, at the Metropolitan Plan/Hennepin Health in Minneapolis, MN where her work focused on caring for high-risk, high-cost populations with a holistic, multidisciplinary approach.  With a strong leadership background, Dr. Foster has worked for a wonderful model of a very integrated system.  She is interested in both management and policy, and her work on health disparities aligns with the fellowship’s goals.  Dr. Foster received her medical degree from the University of Illinois College of Medicine, Chicago, IL in 2001.  She completed her pediatric residency as Chief Resident at the University of Minnesota Pediatric Department, in Minneapolis, MN in 2005.

Data, Diversity and Dollars: Creating a Framework for Building the Business Case for Health Equity

Data, Diversity and Dollars: Creating a Framework for Building the Business Case for Health Equity

(1) To explore critical factors for reducing health disparities and achieving health equity in organizations. 
(2) To identify challenges and barriers to implementing health equity initiatives. 
(3) To understand how health equity initiatives intersect with the Triple Aim to create a framework for the business case for achieving health equity.
Health disparities among subgroups of the population emerged as a major public policy concern over three decades ago. Over time, these policy responses have led to several initiatives, including Healthy People 2020, which includes an overarching goal to “achieve health equity, eliminate disparities, and improve the health of all groups.” In 2015, the American Hospital Association launched its #123forEquity Pledge to Act Campaign as an effort to build on the call to eliminate health disparities and increase health equity by encouraging hospitals and health systems to improve the collection of race, ethnicity and language data (REaL), cultural competency training, and diversity in governance and leadership. Understanding how these health equity initiatives intersect with individual experience of care, health outcomes of populations, and costs of care, helps to create a framework for the economic case for achieving health equity.
A structured review of the literature was conducted to collect relevant data and analyze research on health disparities, health equity, and hospital and health system finance. Key informant interviews were conducted with representatives from several health sectors including hospital systems, state and federal agencies, academic institutions, professional associations and managed care organizations. Data was analyzed, including the 2015 Institute for Diversity in Health Management Diversity and Disparities Benchmarking Survey, case studies, and AHA Equity of Care pledges and goal-tracking summaries.
Strategies that aligned collection of REaL data, cultural competency training, and diversity in leadership & governance were most effective in addressing the Triple Aim and reducing disparities which resulted in cost savings. 
Successful strategies to implementation included: use of evidence-based standardized guidelines (i.e. CLAS standards), EHR expansion (i.e. creating dashboards), community involvement, care coordination, and strategic plan requirements for diversity in workplace.
Diversity in leadership and governance and executive sponsorship was associated with increased likelihood of implementing health equity initiatives.
Barriers to implementing initiatives included: leadership buy-in, political ideology, time and resources, lack of standardized protocols, prescriptive nature, and lack of a business case.
Most organizations have not assessed the economic impact of their health equity strategies.
Future Directions:
(1) Refine evidence-based tools, measurements, and guides to inform next-level research and create a blueprint for scaling equity strategies.
(2) Engage stakeholders in accelerating and scaling strategies, including improving community capacity and payer incentives.
(3) Inform delivery and payment system reform efforts by further defining the business case for health equity by linking health equity strategies to health outcomes and costs.
Preceptors:      Jay Bhatt, DO, MPH, MPA, M. Tomás León, MBA, and Sharon Allen, MBA, American Hospital Association