CMS data shows racial, ethnic, gender disparities in Medicare Advantage care

Significant gender, racial and ethnic differences exist in care received by beneficiaries of Medicare Advantage, according to two reports released by the Centers for Medicare and Medicaid Services.

One report compared quality of care for women and men while the other report looked at racial and ethnic differences in healthcare experiences and clinical care in comparisons among women and men.

The gender report found sizable differences in the quality of treatment for certain conditions among Medicare Advantage beneficiaries, CMS said.

In particular, women received better treatment for chronic lung disease and rheumatoid arthritis and were more likely than men to receive proper follow-up care after being hospitalized for a mental health disorder, CMS said.

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In contrast, women were less likely than men to receive timely treatment for alcohol or drug dependence, and they were more likely to be dispensed medications that are potentially harmful to  certain medical conditions such as dementia.

In eight patient experience measures, women and men get similar care, according to the report. These measures include getting needed prescription drugs, doctors who communicate well, getting appointments and care quickly, and care coordination.

In 24 clinical care measures, 16 were rated as similar for both sexes, five showed women get better care than men and three showed women get worse care than men.

Among the largest disparities in which women received better clinical care included the management of COPD through the use of a bronchodilator and a follow-up visit after a hospital stay for mental illness, within seven days of discharge and also within 30 days of discharge.

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A disparity that favored men included the avoidance of potentially harmful drug and disease interactions in elderly patients with dementia and a history of falls, and also in the initiation of alcohol and drug treatment.

The second report on racial and ethnic group comparisons separated by gender  shows disparities between black and white Medicare Advantage beneficiaries in rates of colorectal cancer screening, treatment for chronic lung disease and acute myocardial infarction.

In racial and ethnic differences for eight patient experience measures, greater disparities of care were reported among men than with women.

With Asian or Pacific Islanders, the report found in seven measures that their experience was rated worse than that of whites among men, compared to female Asian or Pacific Islanders which showed an even split between patient experience being similar or worse than that of whites.

Blacks and Hispanics showed similar patient experience to that of whites in at least five measures.

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In clinical measures, the largest disparities were between blacks and whites, both male and female. In only three out of 24 clinical measures for black men, and in two out of 24 clinical  measures for black women, did the results show better care than with whites.

One big area for disparity was blood pressure control for diabetes care, where black men and women scored lower than all groups.

Hispanics, both female and male, scored the lowest of all groups in measures of avoiding potentially harmful drug-disease interactions in elderly patients with dementia.

In follow up visits after a hospital stay for mental illness within 30 days of discharge, Asian and Pacific Islanders showed the highest measures, whether male or female.

Blacks, male and female, scored the highest on the measure for initiation of alcohol and drug treatment.

The information in the reports will not be used for Part C and D star ratings nor for payment purposes, CMS said.

Providers, researchers and hospital leaders are expected to use the reports to help raise awareness on health disparities and to develop interventions for racially and ethnically diverse Medicare beneficiaries.

The second report follows up on one done in November 2016 by the CMS Office of Minority Health, which presented racial and ethnic group comparisons without looking at gender differences.

"This is the first time that CMS has released Medicare Advantage data on racial and ethnic disparities in care separately for women and men. Showing the data this way helps us to understand the intersection between a person's race, ethnicity, and gender and their healthcare," said Cara James, MD, director of the CMS Office of Minority Health.

CMS Office of Minority Health released the reports in recognition of National Minority Health Month in April. CMS plans to make additional reports available in April.

The reports were prepared in collaboration with the Rand Corporation, and are based on two sources of information scores received in 2014-2015.

The first is from the Healthcare Effectiveness Data and Information Set. HEDIS collects information from medical records and administrative data on the technical quality of care that Medicare beneficiaries receive for a variety of medical issues, including diabetes, cardiovascular disease, and chronic lung disease.

The second source of information is the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, which is conducted annually by CMS and focuses on the healthcare experiences of Medicare beneficiaries nationwide. 

Twitter: @SusanJMorse