CMS: Mix of Racial, Ethnic Disparities in Medicare Advantage

April 11, 2018 - CMS found significant racial and ethnic disparities related to patient experience and chronic disease management in the Medicare Advantage (MA) program, revealing potential health equity concerns within MA.

A report published by CMS and the RAND Corporation found that minority groups experienced poorer overall healthcare experiences than non-minorities during 2016. The team used Medicare CAHPS Surveys and HEDIS data to identify various patterns in healthcare disparities.  

“Compared with white beneficiaries, American Indian or Alaska Native beneficiaries reported worse experiences on six patient experience measures and similar experiences on the other two measures,” the report said.  

“Asian or Pacific Islander beneficiaries reported worse experiences than whites on seven measures and better experiences on one measure. Black beneficiaries reported worse experiences than Whites on two measures and similar experiences on the other six measures.”

There were significant disparities in Medicare Advantage patient experience measures in relation to certain racial and ethnic groups, the team found.

Asian beneficiaries were the only minority group to receive better care in at least one patient experience category than white members. The measure was for annual flu vaccinations.

White Medicare Advantage members had better access to care, more doctors that communicated effectively, better access to needed prescription drugs, and better care coordination than Asian and Native American beneficiaries.

Black and white Medicare Advantage beneficiaries received similar levels of care in almost all patient experience categories. However, white members reported higher rates of annual flu vaccinations and faster access to care than black beneficiaries.

Hispanic beneficiaries also experienced similar patient experiences as white members, but experienced challenges with access to care, getting information about prescriptions, and receiving annual flu vaccinations.

Medicare Advantage clinical care measures generally showed fewer racial and ethnic disparities than indicated by patient experience measures, the team found.

Asian Medicare Advantage members received the best clinical care among all racial groups.

White Medicare Advantage members received worse care than Asian beneficiaries when it came to cancer screenings, diabetes care, pharmaceutical management of COPD, avoiding harmful medications, and follow-ups after a seven-day or 30-day hospital stay.

However, Asian beneficiaries received worse care than whites when it came to antidepressant medication management and substance abuse treatment.

Black Medicare Advantage beneficiaries experienced lower quality clinical care than whites in most clinical care categories.

Black members received worse care than whites for diabetes management, blood sugar control, blood pressure control, beta-blocker treatment after a heart attack, antidepressant management, and follow-up care after a hospital stay.

Black beneficiaries only received higher quality care for a few clinical measures compared to whites. These measures include breast cancer screenings and avoiding potentially harmful medications.

Hispanics experienced slightly fewer disparities than whites in care quality, the team found.

Hispanic Medicare Advantage members received higher quality care than whites for diabetic eye exams, diabetic blood pressure control, breast cancer screenings, and follow-up stays for mental illness hospital visits.

White MA beneficiaries received better care than Hispanic members for managing overall blood pressure, receiving beta-blocker treatment after a heart attack, pharmaceutical therapy for COPD, drug and alcohol treatment, and antidepressant management.

In addition, the team found that performance in certain care quality measures weighed heavily in favor of specific racial groups over others.

Seventy-one percent of Asian Medicare Advantage beneficiaries with diabetes were able to maintain ideal blood pressure ratings of 140/90. In comparison, only 52.2 percent of Black MA beneficiaries, 53.4 percent of white beneficiaries, and 68.6 percent of Hispanic beneficiaries experienced controlled blood pressure.

Significant racial disparities were found in antidepressant adherence to treat depression, the team said.

CMS reported that 75.5 percent of White Medicare Advantage members adhered to antidepressant medication for at least 84 days, while only 67.7 percent of Asian beneficiaries, 62.5 percent of Black members, and 61.4 percent of Hispanic beneficiaries reported similar adherence levels.

Medicare Advantage health plans may need to address racial gaps in healthcare quality through member engagement strategies such as health plan communication and effective provider collaboration.  

“Assessing equitability in the delivery of care requires making comparisons of quality by personal characteristics of patients such as gender, race, and ethnicity,” the report said.