Differences in Receipt of Three Preventive Health Care Services by Race/Ethnicity in Medicare Advantage Plans: Tracking the Impact of Pay for Performance, 2010 and 2013

Abstract

IntroductionIn 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-for-performance (P4P) program, into Medicare Advantage plans. Previous studies documented racial/ethnic disparities in receipt of care among participants in these plans. The objective of this study was to determine whether P4P incentives have affected these disparities in Medicare Advantage plans.MethodsWe studied 411 Medicare Advantage health plans that participated in the Medicare Health Outcome Survey in 2010 and 2013. Preventive health care was defined as self-reported receipt of health care provider communication or treatment to reduce risk of falling, improve bladder control, and monitor physical activity among individuals reporting these problems. Logistic regression stratified by health care plan was used to examine racial/ethnic disparities in receipt of preventive health care before and after the introduction of the P4P program in 2012.ResultsWe found similar racial/ethnic differences in receipt of preventive health care before and after the introduction of P4P. Blacks and Asians were less likely than whites to receive advice to improve bladder control and more likely to receive advice to reduce risk of falling and improve physical activity. Hispanics were more likely to report receiving advice about all 3 health issues than whites. After the introduction of P4P, the gap decreased between Hispanics and whites for improving bladder control and monitoring physical activity and increased between blacks and whites for monitoring physical activity.ConclusionRacial/ethnic differences in receipt of preventive health care are not always in the expected direction. CMS should consider developing a separate measure of equity in preventive health care services to encourage health plans to reduce gaps among racial/ethnic groups in receiving preventive care services.

Complications after discharge predict readmission after colorectal surgery

“…Patient demographics like socioeconomic and race equity are the focus of a CMS Medicare initiative [17, 18]. The results of our study revealed that black race is associated with increased risk of re-admission but that explanatory power is reduced by the inclusion of subsequent clinically discriminative variables.…”

“…Previous studies were centered on fewer parts of the perioperative care continuum with a shorter list of re-admission variables, including some that did not consider complications after discharge [11, 13–15]. Patient demographics like socioeconomic and race equity are the focus of a CMS Medicare initiative [17, 18]. The results of our study revealed that black race is associated with increased risk of re-admission but that explanatory power is reduced by the inclusion of subsequent clinically discriminative variables.…”

Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage

“…13 Similarly, analysis of the Medicare Health Outcome Survey before and after the 2012 implementation of the MA Quality Bonus Payment Demonstration revealed a mixture of better and worse performance on the likelihood of receiving preventive care services depending on race and ethnicity (Black, Asian, and Hispanic) and service use. 14 Findings varied within MA with respect to behavioral health quality as well; Black and Hispanic MA enrollees performed worse than White enrollees on antidepressant medication management, while these same groups performed better (Hispanic) and worse (Black) on follow-up visits after hospitalization for mental illness. 15 Notably, Weech-Maldonado et al not only corroborates previous studies documenting racial and ethnic disparities in health care quality in MA using 2008 and 2009 Consumer Assessment of Healthcare Providers and Systems (CAHPS) and HEDIS measures but also find that measures of racial and ethnic disparities across outcomes within a plan are moderately correlated with one another.…”

Practical Strategies for Assessing Patient Physical Activity Levels in Primary Care

“…22 Per the Quality Bonus Payment Demonstration initiative, data are collected on 48 performance measures, and a quality rating score is given to Medicare Advantage Organizations that determines whether they receive bonus payments and/or rebates for their enrollees. 23 One of these measures is delivery of preventive health care involving “monitoring of physical activity.” 24 In all these cases, systematic PA assessment increases the number of conversations between patients and health care professionals that include PA and leads to greater adherence to HEDIS objectives and related measures.…”