Incentivizing Excellent Care to At-Risk Groups with a Health Equity Summary Score

Abstract

BACKGROUND: Social risk factors (SRFs) such as minority race-and-ethnicity or low income are associated with quality-of-care, health, and healthcare outcomes. Organizations might prioritize improving care for easier-totreat groups over those with SRFs, but measuring, reporting, and further incentivizing quality-of-care for SRF groups may improve their care. OBJECTIVE: To develop, as a proof-of-concept, a Health Equity Summary Score (HESS): a succinct, easy-tounderstand score that could be used to promote highquality care to those with SRFs in Medicare Advantage (MA) health plans, which provide care for almost twenty million older and disabled Americans and collect extensive quality measure and SRF data. DESIGN: We estimated, standardized, and combined performance scores for two sets of quality measures for enrollees in 2013-2016 MA health plans, considering both current levels of care, within-plan improvement, and nationally benchmarked improvement for those with SRFs (specifically, racial-and-ethnic minority status and dual-eligibility for Medicare and Medicaid). PARTICIPANTS: All MA plans with publicly reported quality scores and 500 or more 2016 enrollees. MAIN MEASURES: Publicly reported clinical quality and patient experience measures. KEY RESULTS: Almost 90% of plans measured for MA Star Ratings received a HESS; plans serving few patients with SRFs were excluded. The summary score was moderately positively correlated with publicly reported overall Star Ratings (r = 0.66-0.67). High-scoring plans typically had sizable enrollment of both racial-and-ethnic minorities (38-42%) and dually eligible beneficiaries (29-38%). CONCLUSIONS: We demonstrated the feasibility of developing and estimating a HESS that is intended to promote and incentivize excellent care for racial-and-ethnic minorities and dually eligible MA enrollees. The HESS measures SRF-specific performance and does not simply duplicate overall plan Star Ratings. It also identifies plans that provide excellent care to large numbers of those with SRFs. Our methodology could be extended to other SRFs, quality measures, and settings.

Association of Medicare Advantage Star Ratings With Racial, Ethnic, and Socioeconomic Disparities in Quality of Care

“…An alternative solution would be to formally include a measure of health equity in the calculation of star ratings, 32 providing an increased overall rating to contracts that have lower disparities in care or that are able to reduce their disparities over time. This metric could be implemented in a similar fashion to current adjustments for plans that improve their overall quality, or included as a separate stand-alone measure incorporated into star ratings.…”

Racial and ethnic disparities in care for health system‐affiliated physician organizations and non‐affiliated physician organizations

“…Moreover, the large within‐PO disparities in care we observed highlight the urgency with which providers must identify and address disparities within their own health care organizations using evidence‐based interventions. Public reporting of health equity composite measures 55 at the level of POs or health systems could provide greater accountability for providers to take action to reduce these disparities.…”

Quality, Safety, and Standards Organizations COVID-19 Impact Assessment: Lessons Learned and Compelling Needs

“…To ensure a commitment to constantly improving health systems, research could be conducted on the effectiveness of specifi c training programs to ensure that eff orts to address health inequities and implicit biases are informed by evidence and consistent stakeholder education. Using this evidence, a proof of concept for how health equity could be incorporated into the star ratings for Medicare Advantage Plans to off er a sound, empirically tested starting point [30]. Beyond using existing measures and indices, health equity in care research could also investigate the possibility of using new measures that refl ect timely access to care, equity, and racism to inform and enable systems transformation.…”