Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?

doi:10.1111/1475-6773.12297

. 2015 Dec;50(6):1829-49.

doi: 10.1111/1475-6773.12297. Epub 2015 Mar 11.

Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?

Robert Weech-Maldonado¹, Marc N Elliott², John L Adams³, Amelia M Haviland⁴, David J Klein⁵, Katrin Hambarsoomian², Carol Edwards², Jacob W Dembosky⁶, Sarah Gaillot⁷

Affiliations

¹ Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL.
² RAND Corporation, Santa Monica, CA.
³ Center for Effectiveness and Research, Kaiser Permanente, Pasadena, CA.
⁴ H. John Heinz III College of Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA.
⁵ Department of Pediatrics, Boston Children's Hospital, Boston, MA.
⁶ RAND Corporation, Pittsburgh, PA.
⁷ Division of Consumer Assessment & Plan Performance, Centers for Medicare & Medicaid Services, Baltimore, MD.

PMID: 25757356
PMCID: PMC4693842
DOI: 10.1111/1475-6773.12297

Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?

Robert Weech-Maldonado et al. Health Serv Res. 2015 Dec.

. 2015 Dec;50(6):1829-49.

doi: 10.1111/1475-6773.12297. Epub 2015 Mar 11.

Authors

Robert Weech-Maldonado¹, Marc N Elliott², John L Adams³, Amelia M Haviland⁴, David J Klein⁵, Katrin Hambarsoomian², Carol Edwards², Jacob W Dembosky⁶, Sarah Gaillot⁷

Affiliations

¹ Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL.
² RAND Corporation, Santa Monica, CA.
³ Center for Effectiveness and Research, Kaiser Permanente, Pasadena, CA.
⁴ H. John Heinz III College of Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA.
⁵ Department of Pediatrics, Boston Children's Hospital, Boston, MA.
⁶ RAND Corporation, Pittsburgh, PA.
⁷ Division of Consumer Assessment & Plan Performance, Centers for Medicare & Medicaid Services, Baltimore, MD.

PMID: 25757356
PMCID: PMC4693842
DOI: 10.1111/1475-6773.12297

Abstract

Objective: To examine how similar racial/ethnic disparities in clinical quality (Healthcare Effectiveness Data and Information Set [HEDIS]) and patient experience (Consumer Assessment of Healthcare Providers and Systems [CAHPS]) measures are for different measures within Medicare Advantage (MA) plans.

Data sources/study setting: 5.7 million/492,495 MA beneficiaries with 2008-2009 HEDIS/CAHPS data.

Study design: Binomial (HEDIS) and linear (CAHPS) hierarchical mixed models generated contract estimates for HEDIS/CAHPS measures for Hispanics, blacks, Asian-Pacific Islanders, and whites. We examine the correlation of within-plan disparities for HEDIS and CAHPS measures across measures.

Principal findings: Plans with disparities for a given minority group (vs. whites) for a particular measure have a moderate tendency for similar disparities for other measures of the same type (mean r = 0.51/.21 and 53/34 percent positive and statistically significant for CAHPS/HEDIS). This pattern holds to a lesser extent for correlations of CAHPS disparities and HEDIS disparities (mean r = 0.05/0.14/0.23 and 4.4/5.6/4.4 percent) positive and statistically significant for blacks/Hispanics/API.

Conclusions: Similarities in CAHPS and HEDIS disparities across measures might reflect common structural factors, such as language services or provider incentives, affecting several measures simultaneously. Health plan structural changes might reduce disparities across multiple measures.

Keywords: CAHPS; HEDIS; Medicare; disparities; race/ethnicity.

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Figures

**Figure 1**
Racial/Ethnic Within‐Group and Across‐Group Correlations in CAHPS and HEDIS Measures

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References

1. America's Health Insurance Plans Centers for Policy and Research . 2012. “Low‐Income & Minority Beneficiaries in Medicare Advantage Plans, 2010” [accessed on February 16, 2015]. Available at http://www.ahip.org/MALowIncomeMinorityReport2012/
1. Atherly, A. , and Thorpe K. E.. 2005. Value of Medicare Advantage to Low‐Income and Minority Medicare Beneficiaries. Atlanta, GA: Emory University.
1. Binns, G. S. 1991. “The Relationship among Quality, Cost, and Market Share in Hospitals.” Topics in Health Care Financing 18 (2): 21–32. - PubMed
1. Cella, D. , Yount S., Rothrock N., Gershon R., Cook K., Reeve B., Ader D., Fries J. F., Bruce B., Rose M., and P. C. Group . 2007. “The Patient‐Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap Cooperative Group during Its First Two Years.” Medical Care 45 (5 Suppl 1): S3–11. - PMC - PubMed
1. Centers for Medicare & Medicaid Services . 2014. “Medicare.gov Medicare Plan Finder” [accessed on October 2, 2014]. Available at https://www.medicare.gov/find-a-plan/questions/home.aspx

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[1] America's Health Insurance Plans Centers for Policy and Research . 2012. “Low‐Income & Minority Beneficiaries in Medicare Advantage Plans, 2010” [accessed on February 16, 2015]. Available at http://www.ahip.org/MALowIncomeMinorityReport2012/

[2] America's Health Insurance Plans Centers for Policy and Research . 2012. “Low‐Income & Minority Beneficiaries in Medicare Advantage Plans, 2010” [accessed on February 16, 2015]. Available at http://www.ahip.org/MALowIncomeMinorityReport2012/

[3] Atherly, A. , and Thorpe K. E.. 2005. Value of Medicare Advantage to Low‐Income and Minority Medicare Beneficiaries. Atlanta, GA: Emory University.

[4] Atherly, A. , and Thorpe K. E.. 2005. Value of Medicare Advantage to Low‐Income and Minority Medicare Beneficiaries. Atlanta, GA: Emory University.

[5] Binns, G. S. 1991. “The Relationship among Quality, Cost, and Market Share in Hospitals.” Topics in Health Care Financing 18 (2): 21–32. - PubMed

[6] Binns, G. S. 1991. “The Relationship among Quality, Cost, and Market Share in Hospitals.” Topics in Health Care Financing 18 (2): 21–32. - PubMed

[7] Cella, D. , Yount S., Rothrock N., Gershon R., Cook K., Reeve B., Ader D., Fries J. F., Bruce B., Rose M., and P. C. Group . 2007. “The Patient‐Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap Cooperative Group during Its First Two Years.” Medical Care 45 (5 Suppl 1): S3–11. - PMC - PubMed

[8] Cella, D. , Yount S., Rothrock N., Gershon R., Cook K., Reeve B., Ader D., Fries J. F., Bruce B., Rose M., and P. C. Group . 2007. “The Patient‐Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap Cooperative Group during Its First Two Years.” Medical Care 45 (5 Suppl 1): S3–11. - PMC - PubMed

[9] Centers for Medicare & Medicaid Services . 2014. “Medicare.gov Medicare Plan Finder” [accessed on October 2, 2014]. Available at https://www.medicare.gov/find-a-plan/questions/home.aspx

[10] Centers for Medicare & Medicaid Services . 2014. “Medicare.gov Medicare Plan Finder” [accessed on October 2, 2014]. Available at https://www.medicare.gov/find-a-plan/questions/home.aspx

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Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?

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Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups?

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