Online Program

Narrowing the gap: Trends in racial/ethnic disparities in quality of care in Medicare plans between 2008 and 2012

Wednesday, November 4, 2015 : 10:30 a.m. - 10:50 a.m.

Marc N. Elliott, PhD, RAND Corporation, Santa Monica, CA
Ann Haas, MPH, MS, RAND Corporation, Pittsburgh, PA
John Adams, Kaiser Permanente, Pasadena, CA
Katrin Hambarsoomian, MS, RAND Health, RAND Corporation, Santa Monica, CA
Amelia M. Haviland, PhD, Carnegie Mellon University, Pittsburgh, PA
Jacob W. Dembosky, MPP, RAND Health, RAND Corporation, Santa Monica, CA
David J. Klein, MS, Children's Hospital Boston, Boston, MA
Carol Edwards, PhD, RAND Health, RAND Corporation, Santa Monica, CA
Josh Mallet, RAND Corporation, Santa Monica, CA
Sarah Gaillot, PhD, Centers for Medicare & Medicaid Services (CMS), Baltimore, MD
Samuel C. Haffer, PhD, Office of Minority Health, Centers for Medicare & Medicaid Services, Baltimore, MD
We examined 2008-2012 trends in racial/ethnic disparities in quality of health care provided to Medicare Advantage (MA) beneficiaries overall and within contracts, using both HEDIS and CAHPS quality measures. Logistic regression models compared 2008-2012 national pass rates for 10 process and outcome HEDIS measures for four racial/ethnic groups (non-Hispanic white, Black, Hispanic, and Asian/Pacific Islander [API]). Mean scores were derived from recycled predicted values from a model with Bayesian-enhanced probabilities of race/ethnicity used as predictors. A second set of logistic regression models added contract fixed effects to derive within-contract differences of each minority group from non-Hispanic Whites. Two parallel sets of regression models predicted each of eight CAHPS patient experience measures; these models also included standard CAHPS case-mix adjusters.

HEDIS pass rates for minority MA beneficiaries have improved over time relative to those of non-Hispanic Whites, which have also improved by 2.0-24.4% 2008-2012 for 9/10 measures. API beneficiaries tended to have the highest HEDIS scores of any group in all 5 years, and improved further on most measures. In 2008, Blacks trailed non-Hispanic whites for 9/10 measures, but by 2012 the gap had disappeared or reversed for 2 measures and narrowed for 6 additional measures. Similarly, Hispanics trailed non-Hispanic Whites for 7/10 measures in 2008, but by 2012 the gap had disappeared or reversed for 4 of these measures and had narrowed for the other 3. The largest disadvantage for any minority group in 2008 relative to non-Hispanic Whites was 11.1%; by 2012, the largest was 6.9%. Most of the observed improvement for minorities relative to non-Hispanic Whites was within plans, rather than between plans. Racial/ethnic gaps closed more for process than outcome measures. Whites had higher CAHPS scores than minorities for 5/8 measures from 2008-2012. Of these 5 measures, the racial/ethnic gap narrowed by ~2% for 3 of these measures for each of the 3 minority groups. Improvements were somewhat greater for Blacks and Hispanics than for APIs.

Our findings suggest that efforts to reduce racial/ethnic disparities in clinical quality of care for Medicare Advantage beneficiaries appear to have been successful, especially for process measures. However, additional efforts regarding cultural competence, language, and other steps may be needed to reduce disparities in patient experience. Further improvements may also require addressing between-plan disparities, for example by improving the quality of plans with larger minority representation or by encouraging or facilitating minority beneficiary enrollment in higher performing plans.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Public health or related research

Learning Objectives:
Identify trends in racial/ethnic disparities in quality of health care measures provided to Medicare Advantage beneficiaries between 2008 and 2012. Assess racial/ethnic disparities in healthcare quality overall and within Medicare Advantage contracts using both process and outcome measures.

Keyword(s): Health Disparities/Inequities, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal/co-principal of multiple federally-funded quality-of-care contracts, and lead the contract that funded this work. I have published more than 260 peer-reviewed articles in this area, was named among the world’s 1% of most-cited researchers 2002-2012 by Thomas Reuters, and serve on the editorial boards of HSR, Medical Care R&R, JGIM, and POQ. My interests include quality of care, patient experience, health disparities, vulnerable population, and statistical analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.