Online Program

289455
Do racial/ethnic disparities in quality and patient experience within Medicare plans generalize across measures and racial/ethnic groups?


Tuesday, November 5, 2013 : 8:54 a.m. - 9:06 a.m.

Robert Weech-Maldonado, MBA, PhD, Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
Marc N. Elliott, PhD, RAND Corporation, Santa Monica, CA
Amelia Haviland, PhD, H. John Heinz III College of Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA
John L. Adams, Ph.D., Center for Effectiveness and Safety Research, Kaiser Permanente, Department of Research and Evaluation, Pasadena, CA
David Klein, MS, Children's Hospital Boston, Boston, MA
Katrin Hambarsoomian, MS, RAND Health, RAND Corporation, Santa Monica, CA
Carol Edwards, PhD, RAND Health, RAND Corporation, Santa Monica, CA
Elizabeth Goldstein, PhD, Centers for Medicare & Medicaid Services, Baltimore, MD
Research objectives: To assess the extent to which racial/ethnic disparities in clinical performance and patient experience within Medicare Advantage (MA) plans are similar for different measures and different racial/ethnic groups. Study Population: 2008-2009 MA beneficiaries with Health Plan Employer and Data Information Set (HEDIS)/Consumer Assessments of Healthcare Providers and Systems (CAHPS) data (N=5.7 million/492,495 beneficiaries with HEDIS/CAHPS data) in 441 plans operating in 2009. Study Design: Binomial and linear hierarchical mixed models with random effects for plans and plan by race/ethnicity interactions to produce plan-specific shrunken estimates for each of 7 HEDIS (preventive care indicators) and 7 CAHPS (patient experiences with care) measures for Hispanics, Blacks, Asian-Pacific Islanders, and Whites. Race/ethnicity is self-reported for CAHPS measures and identified by administrative measures enhanced with indirect estimation using surname and residential address for HEDIS. Findings: Positive associations were observed across HEDIS measures (92% positive, mean r=0.27) and across CAHPS measures (87% positive, mean r=0.38) in plan level disparities (vs. Whites). In addition, positive associations across minority racial/ethnic groups in disparities (vs. Whites) for a given measure (81% of HEDIS correlations positive, mean r=0.21; 67% of CAHPS correlations positive, mean r=0.15). Conclusions: System-wide interventions (e.g. language services) targeting the needs and barriers of particular groups may improve health plan performance on multiple measures at the same time. Plans with low disparities for one minority group tend to have lower disparities for other groups, suggesting that uniformity of processes or general commitment to cultural and linguistic best practices may play a role.  

Learning Areas:

Administer health education strategies, interventions and programs
Administration, management, leadership
Diversity and culture
Provision of health care to the public

Learning Objectives:
Assess the extent to which racial/ethnic disparities in clinical performance and patient experience within Medicare Advantage (MA) plans are similar for different measures and different racial/ethnic groups. Discuss the practice and policy implications of racial/ethnic disparities in clinical performance and patient experience within health plans

Keyword(s): Health Disparities, Quality of Care

Presenting author's disclosure statement:

Not Answered