Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions

Li, Yue; Cen, Xi; Cai, Xueya; Thirukumaran, Caroline; Zhou, Jie; Glance, Laurent G.

doi:10.1377/hlthaff.2016.1344

Cited by 25 publications

(38 citation statements)

References 23 publications

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“…Medicare Advantage plans enroll higher proportions of racial/ethnic minorities and enrollees with lower income and education than the traditional Medicare program, and prior work has found substantial disparities in the quality of care in the MA program. [3][4][5][6][7][8][9][10][11][12][13][14] These disparities in care have been found within plans (disparities in quality of care for enrollees in the same plans), and between plans (disparities driven by disproportionate enrollment of minorities in plans with worse quality). 3,13,14 Since 2008, the US Centers for Medicare & Medicaid Services (CMS) has used a 5-star rating system to measure the performance of MA contracts and allocates $6 billion in annual bonus payments on the basis of these star ratings.…”

Section: Introductionmentioning

confidence: 99%

“…Medicare Advantage plans enroll higher proportions of racial/ethnic minorities and enrollees with lower income and education than the traditional Medicare program, and prior work has found substantial disparities in the quality of care in the MA program. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 These disparities in care have been found within plans (disparities in quality of care for enrollees in the same plans), and between plans (disparities driven by disproportionate enrollment of minorities in plans with worse quality). 3 , 13 , 14…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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IMPORTANCE Medicare Advantage (MA) plans, which disproportionately enroll racial/ethnic minorities and persons with socioeconomic disadvantage, receive bonus payments on the basis of overall performance on a 5-star rating scale. The association between plans' overall quality and disparities in quality is not well understood. OBJECTIVE To examine the association between MA star ratings and disparities in care for racial/ ethnic minorities and enrollees with lower income and educational attainment. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 1 578 564 MA enrollees from 454 contracts across the 2015 and 2016 calendar years. Data analyses were conducted between June 2019 and June 2020. EXPOSURES Self-reported race and ethnicity and low socioeconomic status (SES) (defined by low income or less than a high school education) vs high SES (neither low income nor low educational attainment). MAIN OUTCOMES AND MEASURES Performance on 22 measures of quality and satisfaction determined at the individual enrollee level, aggregated into simulated star ratings (scale, 2-5) stratified by SES and race/ethnicity. RESULTS A total of 1 578 564 enrollees were included in this analysis (55.8% female; mean [SD] age, 71.4 [11.3] years; 65.8% White; 12.3% Black; 14.6% Hispanic). Enrollees with low SES had simulatedstratified star ratings 0.5 stars lower (95% CI, 0.4-0.6 stars) than individuals with high SES in the same contract. Black and Hispanic enrollees had simulated star ratings that were 0.3 stars (95% CI, 0.2-0.4 stars) and 0.1 stars (95% CI, −0.04 to 0.2 stars) lower than White enrollees within the same contracts. Black enrollees had a 0.4-star lower rating (95% CI, 0.1-0.7 stars) in 4.5-to 5-star contracts and a no statistical difference in 2.0-to 2.5-star-rated contracts (difference, 0.3 stars; 95% CI, −0.02 to 0.7 stars). Hispanic enrollees had a 0.6-star lower simulated rating (95% CI, 0.2-1.0 stars) in 4.5to 5-star contracts and no statistical difference in 2-to 2.5-star contracts (difference, −0.01 stars; 95% CI, −0.5 to 0.4 stars). There was low correlation between simulated ratings for enrollees of low SES and high SES (difference, 0.2 stars; 95% CI, 0.03-0.4 stars) and between simulated ratings for White and Black enrollees (difference, 0.4 stars; 95% CI, 0.3-0.5 stars) and White and Hispanic enrollees (difference, 0.3 stars; 95% CI, 0.2-0.4 stars). As the proportion of Black and Hispanic enrollees increased in a contract, racial/ethnic disparities in ratings decreased. CONCLUSIONS AND RELEVANCEIn this cross-sectional study, simulated MA star ratings were only weakly correlated with those for enrollees of low SES in the same contract, and contracts with higher star ratings had larger disparities in quality. Measures of equity in MA plans' quality of care may be needed.

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Section: Introductionmentioning

confidence: 99%

“…Medicare Advantage plans enroll higher proportions of racial/ethnic minorities and enrollees with lower income and education than the traditional Medicare program, and prior work has found substantial disparities in the quality of care in the MA program. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 These disparities in care have been found within plans (disparities in quality of care for enrollees in the same plans), and between plans (disparities driven by disproportionate enrollment of minorities in plans with worse quality). 3 , 13 , 14…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…1 Multiple studies have shown racial disparities in hospitalizations, with African-Americans especially experiencing higher readmission rates for chronic conditions, including congestive heart failure, myocardial infarction, pulmonary disease, diabetes, and kidney disease. [2][3][4] Readmission disparities for African-Americans persist despite efforts to manage care and control costs with programs such as Medicare Advantage; one study notably demonstrated a 64% higher readmission rate for African-Americans postoperatively compared to Whites 5 . This inequity extends beyond hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care

et al. 2019

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BACKGROUND: There are many interventions to facilitate seamless continuity of care for patients in transition from hospital back to primary care; however, disparities remain in readmission rates for vulnerable populations, especially African-Americans. OBJECTIVES: We set out to investigate the association of race and ethnicity with 30-day readmission in our urban academic setting and to identify factors that could be leveraged in primary care to address disparities in hospitalizations. METHODS/APPROACH: Using data originally collected for quality improvement purposes, we evaluated 30-day readmission rates for our primary care patients (January 1, 2013-September 30, 2014) by race and ethnicity, adjusting for demographic and clinical characteristics. Then, using inductive and deductive methods, we coded semi-structured interviews with 24 African-American primary care patients who were discharged from the Medicine or Cardiology service at our tertiary care hospital during the study period. KEY RESULTS: African-Americans had the highest readmission rate (21.7%) and a higher adjusted odds of readmission (1.37; 95% CI 1.04-1.81) compared to Whites. Five major themes emerged as having potential to be leveraged in primary care to help prevent multiple hospitalizations: (1) dependable patient-physician relationships, (2) healthcare coordination across settings, (3) continuity with one primary care provider (PCP), (4) disease selfmanagement, and (5) trust in resident physicians. Participants also made several recommendations to keep patients like themselves from returning to the hospital: increased time to tell their story during their primary care visit, more direct patient-physician communication during the visit, and improved access between visits. CONCLUSIONS: While African-American patients in our practice experience higher rates of hospital readmissions than their White counterparts, they emphasize the significance of their PCP relationship and communication to enhance disease management and prevent hospitalizations. Ongoing efforts are needed to establish and implement best practice communication trainings for patients at increased risk of hospitalization, particularly for resident physicians.

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“…24 Similarly, a study of Medicare and Medicare Advantage patients in New York showed that black patients had a higher risk for readmission post-surgery discharge for coronary artery bypass graft than white patients. 32 …”

Section: Discussionmentioning

confidence: 99%

Health System Affiliation and 30-Day Readmission After Heart Attack in Black Men

Williams

Jarosek

Carroll

et al. 2018

American Journal of Preventive Medicine

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Introduction Black patients who experience acute myocardial infarction and receive care in high minority-serving hospitals have higher readmission rates. This study explores how hospital system affiliation (centralized versus decentralized/independent) impacts 30-day readmissions after acute myocardial infarction in black men. Methods In 2018, the Healthcare Cost and Utilization Project State Inpatient Database (2009– 2013) was used to observe 30-day readmission for acute myocardial infarction by race, and data from the American Hospital Association Annual Survey of Hospitals (2009–2013) to determine hospital system affiliation for the states Arizona, California, North Carolina, and Wisconsin. A series of hierarchic logistic regressions were conducted to determine if hospital system affiliation mediates the relationship between race and 30-day readmission. Results Of 63,743 hospitalizations for acute myocardial infarction among men between 2009 and 2013, black men accounted for 7.1% of hospitalizations and 8.0% of readmissions. In both models, race significantly predicted 30-day readmission (unadjusted OR=1.25, 95% CI=1.14, 1.37, p<0.001, AOR=1.13, 95% CI=1.03, 1.25, p=0.046). After controlling for system type, black men were more likely to be readmitted after acute myocardial infarction than white men in both models (unadjusted OR=1.25, 95% CI=1.14, 1.38, p<0.001, AOR=1.14, 95% CI=1.03, 1.25). There was no difference in odds of being readmitted by race and hospital system type (unadjusted OR=0.88, 95% CI=0.25, 3.07, p=0.84, AOR=1.02, 95% CI=0.21, 5.10, p=0.98). Conclusions Black men appear to be more likely to be readmitted after acute myocardial infarction. Centralization does not appear to mediate the relationship between race and 30-day readmissions for acute myocardial infarction.

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Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions

Cited by 25 publications

References 23 publications

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

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

Importance of Communication and Relationships: Addressing Disparities in Hospitalizations for African-American Patients in Academic Primary Care

Health System Affiliation and 30-Day Readmission After Heart Attack in Black Men

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