Racial Disparities Narrowing in Medicare Managed Care
Health Care and Race
While some racial disparities have narrowed substantially, significant racial disparities remain for several important quality measures
Researchers and clinicians recognize that blacks often receive lower quality health care than whites. In an effort to better understand this troubling finding and guide efforts to eliminate these disparities, researchers from Brigham and Women's Hospital (BWH) and Harvard Medical School (HMS) have examined seven years of data from Medicare managed care health plans to determine whether quality has improved and racial disparities have changed from 1997 to 2003.
Researchers found that overall quality of care has improved dramatically for both white and black enrollees in Medicare managed care on most measures, and racial disparities have narrowed for seven of nine clinical performance measures that were studied. However, significant racial disparities still remain, particularly for measures assessing glucose control and cholesterol control for enrollees with diabetes or heart disease, respectively. Details of this research have been published in the August 18, 2005 issue of the New England Journal of Medicine.
"We are encouraged by signs of improved quality of care among blacks and whites, but clearly, we still have a ways to go to ensure access to high quality care for all individuals," said the study's lead author, Amal N. Trivedi, MD, MPH, research fellow in the Division of General Medicine at BWH and the Department of Health Care Policy at HMS.
Senior researcher John Z. Ayanian, MD, MPP, associate professor at BWH and HMS and a practicing internist, added, "Despite improvements in disparate care, the quality of care remains less than optimal for black patients on several key measures."
To assess racial disparities, researchers analyzed data from the Health Plan Employer Data Information Set (HEDIS) - a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans. The BWH and HMS researchers assessed changes over time in quality of care among black and white participants for nine clinical performance measures of health care including breast cancer screening (mammogram), diabetes care (eye examination, testing and controlling blood sugar, and testing and controlling cholesterol) and cardiovascular care (beta-blocker use, and testing and controlling cholesterol).
In this nationally representative study of more than 1.5 million individuals from 183 health plans, all patients were 65 years and older and were self-described as either black or white. Across all nine measures from 1997 to 2003, the absolute increase in HEDIS performance rates ranged from three to 37 percent for white enrollees and from six to 43 percent for black enrollees. On five measures, the difference between whites and blacks in HEDIS performance rates closed to two percent or less.
However, disparities in two of the measures - glucose control for diabetic patients and cholesterol control for cardiovascular patients - did not decrease after adjusting for socioeconomic and geographical factors. The researchers speculate that these ongoing disparities may be related to increasing costs of lipid-lowering and glucose-lowering medications. In addition, researchers believe these disparities could be reduced by increasing the consistency of care delivery through the use of reminder systems, disease management programs and provider feedback, including specific interventions focused on black enrollees and their health care providers.
"Effective collaborations between policy-makers, health plans, clinicians and patients are needed to eliminate these disparities entirely," Trivedi stated. "As a next step, we believe health care organizations should collect quality of care information for different racial, ethnic and socioeconomic groups to help identify and eliminate disparities among their patients."
This study was funded by the BWH Primary Care Research Fund, the federal Agency for Healthcare Research and Quality and the Health Services and Resources Administration.