Racial/Ethnic Disparities in Medicare Beneficiaries’ Care Coordination Experiences

Abstract

Background: Little is known about racial/ethnic differences in the experience of care coordination. To the extent that they exist, such differences may exacerbate health disparities given the higher prevalence of some chronic conditions among minorities. Objective: To investigate the extent to which racial/ethnic disparities exist in the receipt of coordinated care by Medicare beneficiaries. Subjects: A total of 260,974 beneficiaries who responded to the 2013 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Methods: We fit a series of linear, case-mix adjusted models predicting Medicare CAHPS measures of care coordination from race/ethnicity. Results: Hispanic, black, and Asian/Pacific Islander (API) beneficiaries reported that their personal doctor had medical records and other relevant information about their care significantly less often than did non-Hispanic white beneficiaries (−2 points for Hispanics, −1 point for blacks, and −4 points for APIs on a 100-point scale). These 3 groups also reported significantly greater difficulty getting timely follow-up on test results than non-Hispanic white beneficiaries (−9 points for Hispanics, −1 point for blacks, −5 points for APIs). Hispanic and black beneficiaries reported that help was provided in managing their care significantly less often than did non-Hispanic white beneficiaries (−2 points for Hispanics, −3 points for blacks). API beneficiaries reported that their personal doctor discussed their medications and had up-to-date information on care from specialists significantly less often than did non-Hispanic white beneficiaries (−2 and −4 points, respectively). Discussion: These results suggest a need for efforts to address racial/ethnic disparities in care coordination to help ensure high-quality care for all patients. Public reporting of plan-level performance data by race/ethnicity may also be helpful to Medicare beneficiaries and their advocates.

The association between Asian patient race/ethnicity and lower satisfaction scores

“…Similar to other metrics for provider assessment such as cost or clinical quality indicators, patient satisfaction measures may require adjustment for patient characteristics to ensure that reported differences are due to real differences in performance rather than differences in patient mix. Different studies have found patient age, self-perceived health status, education level, sex, marital status, and race/ethnicity (R/E) to be associated with patient satisfaction measures [5][6][7][8][9][10][11][12][13][14][15][16][17]. However, which of these associated patient characteristics should actually be adjusted for in practice to ensure valid comparisons among providers is a debate that has yet to reach consensus [18].…”

“…One such additional patient characteristic that has frequently been studied is patient R/E. A strong trend that has been noted throughout literature regarding satisfaction scores and patient R/E is that Asian patients provide lower patient satisfaction ratings than non-Hispanic white (NHW) patients [16,27] and other R/E groups [7,13,[28][29][30][31][32][33][34]. These studies have utilized various survey instruments such CG-CAHPS, which unlike its inpatient counterpart H-CAHPS is not nationally implemented and is only required for accountable care organizations and group practices participating in Medicare and Medicaid initiatives [35].…”

Imputation of race/ethnicity to enable measurement of HEDIS performance by race/ethnicity

“…There are persistent differences in demographics and MA enrollment by race/ethnicity. We therefore also evaluated the effect of including several CMS administrative demographic and coverage variables in the model: age (categorized as 18‐44, 45‐54, 55‐64, 65‐69, 70‐74, 75‐79, 80‐84, 85‐89, ≥90 years), gender, disability (separately for those less than 65 and 65 or older), dually eligible, low income subsidy (LIS) but not dually eligible, and coverage type (FFS only, FFS with Part D coverage [FFS/PDP], MA‐only, MA with Part D coverage [MA‐PD], and indicators for being in a dual special needs plan [SNP] or chronic condition SNP).…”

A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers

“…In intervention and comparison centers, we invited a random sample of the high-risk (i.e., program-eligible) patients described earlier that had visited the center in the preceding 6 months (N = 5525) to complete the Consumer Assessment of Healthcare Providers and Systems Clinician & Group (CG-CAHPS) survey [56,57] and Patient-Centered Medical Home (PCMH) Supplemental Item Set [57,58]. These surveys assess multiple aspects of patient care experiences, [57,59] and have been used in other studies of care coordination [60,61]. The sites already administered these surveys for performance monitoring.…”