April 17, 2017

How race and gender influence care in Medicare Advantage

Daily Briefing

    The quality of care Medicare Advantage (MA) beneficiaries receive can vary based on a beneficiary's gender and race, according to two CMS reports released Thursday.

    To reduce behavioral health disparities, use these 3 PCP-centered strategies

    Report details

    CMS' Office of Minority Health in collaboration with the RAND Corporation prepared two reports that focus on the disparities in MA care among beneficiaries of different genders and races. The first report compares the quality of care among women and men, while the second report examines differences in care by race and gender.

    For the reports, researchers from CMS and RAND analyzed clinical care data from medical records and insurance claims for hospitalizations, medical office visits, and other procedures. The data were pulled from the Healthcare Effectiveness Data and Information Set and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey.

    The researchers measured quality of care disparities based on eight patient experience measures and 24 clinical care measures, including whether:

    • Appropriate treatment was provided to beneficiaries with chronic obstructive pulmonary disease (COPD);
    • Beneficiaries received annual flu vaccines;
    • Beneficiaries received appropriate screening for colon cancer;
    • Beneficiaries with diabetes received blood sugar tests; and
    • Doctors communicated well with beneficiaries.

    Cara James, director of CMS' Office of Minority Health, said the reports help "to understand the intersection between a person's race, ethnicity, and gender and their health care."

    Findings on gender disparities

    In its report focusing on quality of care differences between women and men, the researchers found that women tend to receive better care than men for certain health conditions, such as chronic lung disease and rheumatoid arthritis. However, the researchers found that men received better care than women for dementia and falls. Specifically, the researchers found that:

    • 80.4 percent of women with COPD exacerbations received a bronchodilator within 30 days, compared with 76.8 percent of men;
    • 78.7 percent of women diagnosed with rheumatic arthritis received at least one prescription for a disease-modifying antirheumatic drug (DMARD), compared with 75.6 percent of men;
    • 52.2 percent of women were prescribed a dementia treatment that potentially could have harmed them, compared with 43.9 percent of men; and
    • 50.3 percent of women were prescribed a potentially harmful therapy to treat a history of falling, compared with 39 percent of men.

    In addition, the researchers found that women were more likely than men to receive follow-up care after being hospitalized for a mental health disorder. According to the report, 57.2 percent of women who were hospitalized for a mental health disorder had a follow-up visit within 30 days of discharge, compared with about 50 percent of hospitalized men.

    Findings on racial, ethnic disparities

    In its report focusing on quality of care differences between MA beneficiaries of different races, the researchers found that the most significant disparities existed between care provided to blacks and whites.

    Overall, the researchers found that white MA beneficiaries reported better care experiences than blacks, Hispanics, and Asian/Pacific Islander (API) MA beneficiaries. For instance, the researchers found that white beneficiaries with new diagnoses of major depression were more likely to remain on an antidepressant medication for at least 180 days when compared with API, black, and Hispanic beneficiaries.   

    However, the report showed that, in some cases, Hispanic and API women reported better care than white and black women. For instance, the researchers found that 76.1 percent of Hispanic women and 75.6 percent of API women were appropriately screened for colorectal cancer, compared with 65.4 percent of white women and 62.3 percent of black women.

    The researchers found similar trends among men, with 73.6 percent of Hispanic and API men receiving appropriate screening for colorectal cancer, compared with 63.8 percent of white men and 57.1 percent of black men.

    In some instances, though, women and men of all races and ethnic groups experienced similar care, according to the report. For example, the researchers found similar rates of blood sugar testing, kidney disease monitoring, testing to confirm COPD, prescriptions for managing rheumatoid arthritis, and monitoring long-term medication use among all demographics.

    (Livingston, Modern Healthcare, 4/13; Morse, Healthcare Finance News, 4/13; AHA News, 4/13; Gender Disparities in Health Care in Medicare Advantage, CMS' Office of Minority Health/RAND Corporation, April 2017; Racial and Ethnic Disparities by Gender in Health Care in Medicare Advantage, CMS' Office of Minority Health/RAND Corporation, April 2017).

    How to address health inequity in your community

    With the shift in health care to focus on optimizing the health of individuals and communities, health care organizations are creating new strategies to address health care disparities in access and patient outcomes.

    Advisory Board has created the Health Disparities Initiative, which provides actionable resources on a series of strategic imperatives and special topics to achieve equity of care. Interested in seeing research or resources that address your biggest health equity problems?

    Download our resource, "Building Community Partnerships to Reduce Disparities," which includes studies featuring providers who have successfully partnered with community organizations to address health disparities and social determinants of health. You'll also find tools that can guide your organization’s community partnership strategy.

    DOWNLOAD THE RESOURCE

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