By Irfan Shariff
Northwest Asian Weekly
Wellness starts with having a relationship with a primary care provider (PCP), said Dr. Mark Maddox of MultiCare Connected Care (MCC), an accountable care organization (ACO) based in Tacoma, Wash.
In addition to designating a PCP, Maddox said that annual evaluations, developing a preventive plan that includes regular and special screenings, immunizations, and conversations around personal risk factors are key to maintaining wellness.
With a PCP, “You have someone to fall back on…if you don’t, it can result in urgent care,” Maddox said, which can create fragmented care. “That is a real challenge.”
Maddox has a clinical background as a colorectal surgeon, but for the last decade has focused on the population health space and working with ACOs. An ACO is a group of hospitals, doctors, and health care providers that come together to give coordinated care to specific populations, like Medicare patients.
Organizations like MCC, a wholly independent business established by MultiCare Health System in 2014, focus on the triple aim of healthcare — improving the patient experience, improving the health of communities, and reducing the cost of care.
MCC and doctors like Maddox sometimes add a fourth aim: improving provider satisfaction.
Similarly, Michael McKee, who oversees the health education and community advocacy programs at International Community Health Services (ICHS), also recommends developing a relationship with a PCP and “knowing the value of regular checkups, including dental screening…and your personal and family history.”
“ICHS serves an incredibly diverse patient population, many of which are immigrants and refugees,” said McKee. The idea of seeing a provider before you get sick is often unfamiliar to many of these communities.”
There isn’t good data on community-specific health concerns for the Asian Pacific Islander (API) communities and small numbers of self-reporting in some studies, according to Maddox.
But there are some malignancies that seems to occur at a higher rate in API communities, particularly gastrointestinal malignancies and liver cancer, as well as a higher rate of Hepatitis B infection which is one of the causes of liver cancer. Citing the Maryland-based Asian American Health Initiative (AAHI, aahiinfo.org), which was founded in 2005, Maddox said Hepatitis B-related deaths are seven times greater in the API population than the white American population. The Hepatitis B virus can be prevented through vaccination.
AAHI notes that the API community is the only American population segment to suffer from cancer as the leading cause of death, and has the highest rates of stomach cancer. AAHI also found that API women have the lowest screening rate for breast cancer compared to other groups.
Anyone age 50 and over should also be screened for colorectal cancer, said Maddox. “Colon cancer is a preventable disease through early screenings.”
API women also run a high risk for osteoporosis development because the average calcium intake for Asian women is about half of that of Western populations, according to AAHI.
“Westernized diets also lead to a greater risk of obesity in immigrant communities,” said Maddox. “It should be counterbalanced with activity.”
And he said it’s always worth considering a flu shot.
Despite the availability of recommendations and resources, there are disparities in care that stem from cultural or economic differences.
According to McKee, “Most studies suggest that the social determinants of health, including health care access, are responsible for about 75 percent of health outcomes. In other words, only 25 percent of health is related to genes of biology and personal behaviors.”
AAHI cites the model minority myth and the varying socio-economic backgrounds of the different API communities. Even though places like ICHS offer a sliding scale fee, cost still matters.
According to the 2016 National Healthcare Quality and Disparities Report from the Agency for Healthcare Research and Quality, there was an 80 percent improvement in quality of care when it was person-centered, or the patient is actively engaged in their wellbeing.
Often a person’s culture influences their willingness to seek a physician, said McKee, but by “teaching patients that they are in control of their health” and “treating a person as a whole,” it builds trust, enhances the healthcare experience, and increases the potential for a positive outcome.
Irfan can be reached at email@example.com.