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Advancing Health Equity in Medicare

Dr. Cara James - Director of the CMS Office of Minority Health
Monday, July 25, 2016

The Office of Minority Health (OMH) at the Centers for Medicare & Medicaid Services (CMS) - established through the Affordable Care Act - is dedicated to working on behalf of all CMS beneficiaries while strategically focusing on racial and ethnic minorities, individuals with disabilities, and sexual and gender minorities.

The work of the CMS Office of Minority Health approaches health equity through a framework that promotes Understanding and awareness of disparities and their causes among its beneficiaries; creating and sharing Solutions; accelerating the implementation of effective Actions. 

Under this framework, we released the CMS Equity Plan to Improve Quality in Medicare, that includes six priorities for advancing health equity by improving the quality of care provided to racial and ethnic minority and other underserved Medicare beneficiaries. In an effort to increase understanding and awareness of health disparities among CMS beneficiaries, we recently released detailed Medicare Advantage data stratified by race and ethnicity. 

This is the first time CMS has released such data, and it comes at a time when minority beneficiary enrollment in Medicare Advantage is higher than ever before. The Medicare Payment Advisory Commission (MedPAC) and Medicare Current Beneficiary Survey (MCBS) data have reported that up to 44% of Hispanic Medicare beneficiaries- an increase from 35% in 2009 - and over 31% of African American Medicare beneficiaries – an increase from 28% in 2009 - are enrolled in Medicare Advantage plans. 

Our data, based on an analysis of the Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey, presents HEDIS and CAHPS scores for different racial and ethnic groups at the level of individual Medicare contracts. Unfortunately, data are not available for all racial and ethnic groups for all contracts.  Medicare Advantage contracts not listed means we did not have enough information from the sample of members used to report reliably at the time this report was generated. It is our intent to collaborate with health plans and providers to report the most complete and accurate data, analysis, and insight in the future.

In addition to our report on Medicare Advantage, we also recently released the Mapping Medicare Disparities (MMD) Tool which evaluates disparities in fee-for-service (FFS) Medicare. The MMD Tool presents information regarding health outcome measures for disease prevalence, costs, and hospitalization for 18 specific chronic conditions, emergency department utilization, readmissions rates, mortality and preventable hospitalizations based on CMS administrative claims data for FFS Medicare beneficiaries.

In 2014, two-thirds of Medicare beneficiaries had multiple chronic conditions and accounted for 94 percent of Medicare spending. Racial and ethnic minorities experience disproportionately higher rates of disease, lower quality of care, and reduced access to care as compared to their white counterparts.

While these data do not tell us why health disparities exist in FFS Medicare and Medicare Advantage, they help us understand where we have opportunities to improve.  We look forward to working with organizations like the Better Medicare Alliance, plans, and providers to identify best practices and spur initiatives to reduce or eliminate these differences.