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

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.