CMS Reports Show Disparities in Care by Ethnicity, Gender, Race

Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in MA and Medicaid managed care. 

By Lauren Flynn Kelly, Managing Editor

April 27, 2017 Volume 23 Issue 8

Two new reports examining the quality of care received by Medicare Advantage enrollees reveal several nuances in the patient experience as reported by ethnic/racial group and gender, as well as “sizable differences” in the quality of treatment for certain conditions among MA beneficiaries, such as black and white men with rheumatoid arthritis, observes CMS. Health plans are encouraged to use the new observations to examine their own data and find areas where they can make improvements in delivering care quality.

In a first-ever look at quality-of-care data stratified by contract and ethnicity, CMS in April 2016 observed significant health disparities between minority groups and whites in MA plans (MAN 4/21/16, p. 1). Examining the 2013 and 2014 quality measures, CMS and its research partner RAND Corp. noted there was considerable variation in which racial and ethnic groups scored best and worst on particular items. For instance, blacks and Hispanics scored better than whites in the doctor-communications category, and Asians scored higher than whites in the “all clinical care measures” item as well as in getting timely flu vaccinations. This year’s analyses went one step further to report on racial and ethnic disparities in care separately for men and women.

“Our health outcomes are the result of a combination of the many social factors who make up who we are, such as our race or ethnicity, sex, socioeconomic status, and social relationships. It is not always possible to look at the intersection between many of these groups, but when we can, we think it is important to do so,” explains Cara James, Ph.D., director of the CMS Office of Minority Health, which posted the reports on April 13. “For example, while we can look at the relationship between race, ethnicity and gender at the national level, we are unable to look at the measures at the contract level the way we can when looking just at race and ethnicity.”

Data Highlight Weak Spots for Plans

CMS’s hope, James tells AIS Health, is that this information will encourage health plans to take a closer look at their data to see where they have disparities, and to examine the different populations they serve to identify where there’s room for improvement. “Once they’ve identified their gaps, they can decide where they would like to focus their efforts and develop a plan of action to drive down disparities,” she says.

For the latest report, CMS and RAND analyzed 2014 and 2015 data from two sources of information — HEDIS and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) — used in the agency’s star quality ratings for MA plans. These analyses are separate from the star-ratings program and will not be used for payment purposes, noted CMS.

In one report, CMS compared eight patient experience measures and 24 clinical care measures summarizing HEDIS data for women vs. men. CMS found that women received similar care on 16 of the clinical care measures, while the care received by women on certain measures was higher by at least three percentage points on five measures. For example, 74.6% of women with diabetes had an eye exam in the past year, compared with 71.4% of men detected in that measure, and 78.7% of women were treated in the rheumatoid arthritis management measure, compared with 75.6% of men.

“I find it interesting that most of the differences reported between men and women are relatively small, with the exception of: 1) avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls, [and] 2) avoiding potentially harmful drug-disease interactions in elderly patients with dementia, where there is nearly a 10 percentage point difference with the standard of care to be less often met in women,” adds James.

A comparison of the patient experience measures informed by the CAHPS survey indicated that men and women generally experienced similar care, but a second report showing racial and ethnic group comparisons separately for men and women told a slightly different story. “Another finding of interest is the large variation in all patient experience measures for Asian and Pacific Islander men relative to white men, and the disparities for Asian and Pacific Islander women compared to white women,” observes James. Asian/Pacific Islander women, for example, reported worse experiences than whites for four of the eight patient experience measures, and Asian and Pacific Islander men reported worse experiences for seven of the eight measures.

Gender, Race Disparities Varied by Treatment

That report also showed that differences in the rates of colorectal cancer screening, treatment for chronic lung disease and acute myocardial infarction for black and white MA beneficiaries are greater in men than in women. For example, the 2015 data showed that 62.3% of black women ages 50 to 75 had appropriate screening for colorectal cancer, compared with 65.4% of white women, while 57.1% of black men received that screening, compared with 63.8% of white men.

Likewise, disparities in the management of rheumatoid arthritis for black and white MA enrollees were larger for men. The 2015 data indicated that 78.1% of black women who were diagnosed with rheumatoid arthritis in the past year were dispensed at least one ambulatory prescription for a disease-modifying antirheumatic, compared with 79.1% of white women, while 69.1% of black men and 76.6% of white men received a DMARD according to that measure. The CMS Office of Minority Health in November 2016 released similar data in November 2016 without stratifying by gender.

“One of the findings that I think is worth noting is the number of measures where regardless of an individual’s race, ethnicity or gender, we have room to improve,” adds James. She points out that the data showed that “barely half” of black and Hispanic men and women with diabetes have their blood pressure under control, while “at the other end of the spectrum” three-quarters of Asian and Pacific Islander men and women with diabetes have their blood pressure in check.

View both reports at http://tinyurl.com/mqksz76.

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