Association of Medicare Advantage Star Ratings With Racial and Ethnic Disparities in Hospitalizations for Ambulatory Care Sensitive Conditions

Abstract

Background: Enrollment in high-quality Medicare Advantage (MA) plans, measured by a 5-star quality rating system, was lower among racial and ethnic minority enrollees than White enrollees partly due to fewer high-quality plans available in their counties of residence. This may contribute to racial and ethnic disparities in ambulatory care sensitive condition (ACSC) hospitalizations.Objective: We examined whether there were racial and ethnic disparities in ACSC hospitalizations among MA enrollees overall and by star rating.Methods: Using the Medicare enrollment and claims data for 2016, we identified White, Black, Hispanic, and Asian/Pacific Islander enrollees in MA plans. We estimated racial and ethnic disparities in ACSC hospitalizations (per 10,000 enrollees) overall and by star rating.Results: We found that the adjusted rates of ACSC hospitalizations were significantly higher among Black enrollees than White enrollees overall [39.4 (95% confidence interval: 36.3-42.5)]. However, no significant disparities were found among Hispanic and Asian/Pacific Islander enrollees. The adjusted rates of ACSC hospitalizations were higher in lower-rated plans than higher-rated plans in all racial and ethnic groups. The significant disparities in ACSC hospitalizations by star rating were the most pronounced between White and Black enrollees. We found suggestive evidence that enrollment in lower-rated plans was associated with higher disparities in ACSC hospitalizations between White and Black enrollees.Conclusions: Substantial disparities in ACSC hospitalizations exist between White and Black enrollees in MA plans, especially for lower-rated plans. Policies aimed at reducing racial disparities in ACSC hospitalizations could include improving access to highrated plans.

Medicare Advantage Plan Star Ratings and County Social Vulnerability

“…The median county-level star rating was 4.1 (IQR, 3.9-4.3) in Q1 counties (lowest social vulnerability) and 3.8 (IQR, 3.6-4.0) in Q5 counties (highest social vulnerability) (P < .001) (Table ). The median number of highest-rated plans in a county was highest for Q3 counties (14 [IQR,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)) and lowest for Q5 counties (11 [IQR, 8-15]) (P < .001) (Table ). However, the median number of low-rated plans in a county was highest for Q5 counties (4 [IQR, 2-8]) and lowest for Q1 counties (2 [IQR, 0-4]) (P < .001) (Table ).…”

“…Racial and ethnic disparities in hospitalizations for ambulatory care–sensitive conditions have been found to be higher in low-rated vs high-rated MA plans. 11 This could suggest that low-rated plans might be lacking the resources or priorities to invest in quality or equity, leading to widened disparities.…”

“…Given that socioeconomically disadvantaged and racial and ethnic minority beneficiaries have less health care access and utilization than their more advantaged peers, it is possible that MA plans serving a higher proportion of such beneficiaries have lower star ratings. Racial and ethnic disparities in hospitalizations for ambulatory care–sensitive conditions have been found to be higher in low-rated vs high-rated MA plans . This could suggest that low-rated plans might be lacking the resources or priorities to invest in quality or equity, leading to widened disparities.…”

“…Park et al found that racial and ethnic minority enrollees had on average a lower number of high-rated plans (≥4.0 stars) and a higher number of low-rated plans (≤3.5 stars) in their counties of residence. Park et al also found that lower enrollment of racial and ethnic minority enrollees in plans rated 4.0 to 4.5 stars compared with White enrollees was in part associated with the lower availability of high-rated plans in their counties of residence.…”