Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups? |
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| Authors: | Robert Weech‐Maldonado PhD Marc N Elliott PhD John L Adams PhD Amelia M Haviland PhD David J Klein MS Katrin Hambarsoomian MS Carol Edwards BA Jacob W Dembosky MPM Sarah Gaillot PhD |
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| Affiliation: | 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 |
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| Abstract: | ObjectiveTo 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 Setting5.7 million/492,495 MA beneficiaries with 2008–2009 HEDIS/CAHPS data.Study DesignBinomial (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 FindingsPlans 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.ConclusionsSimilarities 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. |
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| Keywords: | Medicare disparities
CAHPS
HEDIS
race/ethnicity |
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