Enrollment in Medicare Advantage managed care plans reduces racial/ethnic disparities in primary care quality in some States

Patients enrolled in Medicare Advantage (MA) plans had a lower incidence of preventable hospitalizations than those enrolled in fee-for-service (FFS) Medicare across all racial/ethnic groups, found a new study. In California, white MA patients were 19 percent less likely than white FFS patients to have preventable admissions (versus marker admissions), while blacks and Hispanics were 29 percent and 28 percent respectively less likely than their FFS counterparts to have preventable admissions. In Florida, black and Hispanic MA patients were 16 percent and 25 percent, respectively less likely than their FFS counterparts, and white MA patients were 11 percent less likely than white FFS patients to have preventable hospitalizations. In New York, white and Hispanic MA patients were 7 percent and 14 percent respectively less likely than their FFS counterparts to have preventable admissions.

Since these hospitalizations are typically prevented by access to quality primary care, the finding suggests that MA plans may improve the quality of primary care across races, notes study author, Jayasree Basu, Ph.D., M.B.A., of the Agency for Healthcare Research and Quality (AHRQ). It appears that minorities may have benefited more from these managed care plans than whites, given that the negative association between MA enrollment and the likelihood of preventable hospitalization is stronger for minorities than whites. The author notes that greater efforts at care coordination and provision of primary and preventive care in managed care plans may actually be more beneficial for minorities, especially since they are the vulnerable groups needing such supports.

Since many previous studies reported that minorities have higher rates of preventable hospitalizations, a lower risk among minorities than among whites could hold the potential for MA plans to lessen racial/ethnic inequalities in primary care, notes Dr. Basu. Her findings were based on analysis of 2004 hospital discharge data from AHRQ's Healthcare Cost and Utilization Project State Inpatient Database for the three States. Dr. Basu notes that, through 2005, health maintenance organizations—created to provide better care coordination than other types of MA plans—were the dominant form of MA option.

More details are in "Medicare managed care and primary care quality: Examining racial/ethnic effects across states," by Dr. Basu, in Health Care Management Science published online September 3, 2011. [Epub ahead of print.] Reprints (AHRQ Publication No. 12-R014) are available from the AHRQ Publications Clearinghouse.