Health Reform WK-EDGE New data will help identify, eliminate disparities in patient experience, care
Monday, May 2, 2016

New data will help identify, eliminate disparities in patient experience, care

By Patricia K. Ruiz, J.D.

Members of racial and ethnic minority groups continue to experience worse outcomes than non-minorities, according to a new CMS analysis of Medicare Advantage (MA) and Part D performance data. The data, collected into a new database, will help increase understanding and awareness of disparities and their causes and will aid CMS in addressing and eliminating such disparities. The reporting and public posting of this data is required under sec. 4302 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) (CMS Report, April 20, 2016).

Quality measures. The data presented focuses on the analysis, reporting, display, and dissemination of existing quality measures, stratified by race and ethnicity. Quality measures fall into two categories: patient experience and clinical care. Patient experience measures include how easy it is to get care, how well doctors communicate with beneficiaries, and how easy it is for beneficiaries to get information about prescription drug coverage and cost. Clinical care measures include whether beneficiaries received appropriate screening for colon cancer, whether beneficiaries with diabetes received proper tests to determine whether blood sugar is under control, and whether beneficiaries with hypertension had their blood pressure controlled adequately.

Disparities. The data shows overall differences in care that is delivered to Medicare beneficiaries who identify as Asian or Pacific Islander (API), Black/African American, Hispanic, or White. showed that Asians and Pacific Islanders usually received care similar or better than the care received by Whites, but African Americans and Hispanics typically received care that was similar or worse than that received by Whites. African Americans and Hispanics also reported similar or worse health care experiences than reported by Whites. For example, for all patient experience measures, seven out of eight American Indian or Alaska Natives (AI/ANs) had similar or worse experiences compared to Whites, seven out of eight APIs had worse experiences compared to whites, eight out of eight Black or African Americans had similar or worse experiences compared to Whites, and eight out of eight Hispanics had similar or worse experiences compared to Whites.

Sources of data. The data is based on an analysis of two sources of information: (1) the Healthcare Effectiveness Data and Information Set (HEDIS), which collects information from medical records as well as administrative data on how well the needs of beneficiaries are being met for a variety of medical issues; and (2) the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey, which is collected annually and focuses on the health care experiences of Medicare beneficiaries nationwide.

While the data is used to target quality improvement activities and resources, to monitor health and drug plan performance, and to advance the development of culturally and linguistically appropriate quality improvement interventions and strategies, the data does not come into play in the determination of MA and Part D Star Ratings and are not used for payment purposes.

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