Our aging population is becoming more racially and ethnically diverse – a phenomenon that raises questions on how we should deal with persistent health disparities in Medicare.
According to the U.S. Census, over 21% of the senior population or 9.5 million people belong to a racial and/or ethnic minority group - an increase from 6.3 million in 2003 (17.5% of older adults). That number is projected to increase to 21.1 million in 2030 (28.5% of older adults).
Despite reforms implemented through the Affordable Care Act (ACA) and though health indicators such as life expectancy have improved for most Americans, racial and/or ethnic seniors still experience a disproportionate burden of chronic disease, death, and disability even when they have the same insurance and socioeconomic status as their non-minority counterparts.
Recently, the Commonwealth Fund reported poorer health outcomes among African Americans due cost-related barriers to care and how current changes in the healthcare landscape offer opportunities to close the equity gap.
Unfortunately, the report did not mention Medicare Advantage or Part C, which is private, managed care that now includes over a third of Medicare beneficiaries. A recent issue brief from BMA examined enrollment growth in Medicare Advantage and determined that access to high-quality plans is high.
What does this mean for minority beneficiaries? Can the accessibility of Medicare Advantage translate into a reduction in gaps in care for minority beneficiaries on Medicare?
After all, currently 44% of Hispanic Medicare-eligible beneficiaries choose Medicare Advantage, the number is 31% among African Americans and growing. 57% of individuals dually eligible for Medicaid and Medicare in Medicare Advantage represent racial or ethnic minority populations compared to 47% in the Traditional FFS Medicare.
Why is Medicare Advantage popular with minority beneficiaries in Medicare? Unlike Traditional Fee-For-Service Medicare, Medicare Advantage enables disease management programs and care coordination services that are particularly important for low-income beneficiaries of diverse origins, who are more likely to have multiple chronic diseases. The flexibility of Medicare Advantage could offer minority beneficiaries better quality care, better management of chronic conditions, additional benefits, and more affordability.
There are signs of success that Medicare Advantage is successfully moving towards elimination of racial/ethnic disparities.
Recently RAND researchers found that Medicare Advantage plans have had positive trends in closing racial/ethnic disparities in quality of health care HEDIS measures between 2008 and 2012. The authors concluded that their “findings suggest that efforts to reduce racial/ethnic disparities in clinical quality of care for Medicare Advantage beneficiaries appear to have been successful.”
A more specific example is in the area of breast cancer care, where a study published in the Journal of Racial and Ethnic Health Disparities found that compared to Medicare fee-for-service, ethnic and racial disparities for breast cancer care were reduced for Medicare Advantage enrollees. This could be attributed to the emphasis on prevention and primary care in Medicare Advantage. University of Michigan researchers recently reported higher rates of mammography in Medicare Advantage as associated with a reversal of racial and ethnic differences observed in traditional Medicare.
University of Michigan researchers also found that Medicare Advantage plans were largely able to eliminate disparities for risk-factor control for hypertension, cardiovascular disease, and diabetes in Western states from 2006 through 2011 as a result of their disease management programs.
The study's authors noted that Medicare Advantage chronic disease management programs focused on developing targeted interventions to improve patient care and outcomes led to better overall outcomes for patients including:
• 62% reduction in serious heart attacks
• 42% decline in stroke mortality
Evidence-based interventions and focused quality improvement efforts are effective tools for reducing health disparities. This is encouraging news as health disparities persist in traditional Medicare and Medicare Advantage and a remain a serious challenge as more minority beneficiaries become Medicare-eligible. The fact is that disparities in health are preventable. All of us in health care must make the commitment essential to identifying and addressing disparities in quality of care.