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  • Slide 1
  • Trends in Health Care Disparities in Medicare Managed Care Sarah Hudson Scholle, MPH, DrPH AcademyHealth June 27, 2005
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  • AcknowledgementsAcknowledgements Research Team Sarah Hudson Scholle, DrPH, NCQA Beth Virnig, PhD, University of Minnesota Ann Chou, PhD, NCQA Sarah Shih, MPH, NCQA Russ Mardon, PhD, NCQA Rich Mierzejewski, MA, NCQA Funded by the California Endowment
  • Slide 3
  • BackgroundBackground IOM: care should be safe, effective, patient- centered, timely, efficient, equitable. Numerous reports of disparities in health care and health outcomes, including previous studies found disparities in Medicare managed care Quality has improved over time in Medicare managed care: what about the disparities? The purpose of this study is to examine trends in quality of care for blacks and whites in Medicare managed care
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  • Data Sources Medicare HEDIS data Health plans report member-level HEDIS data to NCQA separately from plan-level data 1998 to 2003 measurement years Excluded plans where rates calculated from member-level data did not agree with audited plan-level rates CMS enrollment file Age, sex, race/ethnicity, zip code, eligibility Race/ethnicity assigned at enrollment in Social Security Linked to HEDIS data using unique identifier (> 90% match) U.S. Census data Zip code matched to obtain median household income for persons age 75-84
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  • Medicare HEDIS Measures Breast Cancer Screening (hybrid) Comprehensive Diabetes Care (hybrid) HgbA1c screening, Poor control of HgbA1c, Eye exam, Nephropathy, Lipid screening, Lipid Control Cholesterol Management After Acute Cardiovascular Event (hybrid) Lipid screening, Lipid Control Controlling High Blood Pressure (hybrid) Beta Blocker After Heart Attack (hybrid) Antidepressant Med Mgmt (admin only) Optimal Contacts, Acute Phase Treatment, Continuation Phase Treatment Follow-up After Mental Health Hospitalization within 7 or 30 days (admin)
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  • Study Group, 2003 Plans Eligible Members MeasureWhiteBlack Breast Cancer Screening146 181,595 18,732 Comprehensive Diabetes Care148 83,269 12,938 Cholesterol Management145 24,454 2,060 Controlling High Blood Press.141 46,292 7,237 Beta Blocker After Heart Attack141 13,766 1,302 Antidepressant Med Mgmt122 27,235 1,439 Follow-Up After MH Hosp139 7,425 883
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  • Analytic Approach: Trends over Time Research questions: Does performance differ by race? Does performance change over time? Does the rate of change in performance differ between whites and blacks? Approach: Logistic regression analyses modeling each quality indicator (met/not met) Controlling for patient age, sex, household income, region, plan size Used a continuous variable to test for temporal correlation
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  • Cholesterol Screening and Control Acute Cardiac Events Adjusted OR Screening Control Race: 0.638***0.575*** Time: 1.439*** 1.420*** Race*Time: 0.9751.001
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  • Cholesterol Screening and Control - Diabetics Adjusted OR Screening Control Race: 0.685*** 0.653*** Time: 1.816*** 1.382*** Race*Time: 0.993 1.031***
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  • Diabetes HbA1c Screening and Control Adjusted OR Screen Control Race: 0.748*** 1.459*** Time: 1.424*** 0.825*** Race*Time: 1.011 0.984 Lower is better.
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  • Beta Blocker & Blood Pressure Adjusted OR BBH HBP Race: 0.838** 0.782*** Time: 1.626*** 1.351*** Race*Time: 0.934* 1.002
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  • Antidepressant Medication Management Adjusted OR Acute Continuation Contacts Race: 0.589*** 0.544*** 1.024 Time: *** ***NS Race*Time: NS NSNS
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  • Follow Up After Mental Health Hospitalization (30 Days) Adjusted OR Race: 0.537*** Time: 1.163*** Race*Time: 1.028
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  • Breast Cancer Screening Adjusted OR Race: 0.911*** Time: 1.021*** Race*Time: 1.030***
  • Slide 15
  • Magnitude of Racial Disparity Differs Adjusted Odds Ratio B-W Diff in Adjusted Rate Blacks gaining or losing Breast Cancer Screening0.911.2 + Diabetes HgbA1c screen0.753.2 Diabetes LDL screen0.693.8 Controlling High Blood Pressure0.785.2 Beta Blocker after Heart Attack0.845.7 - Diabetes LDL control


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