Medicare Advantage enrollees in different racial and ethnic groups report disparities in clinical outcomes even though they have similar self-reported patient experiences, according to a report from the CMS Office of Minority Health and the RAND Corp.1
For example, Asian American and Native Hawaiian and other Pacific Islander, Black and multiracial MA members reported receiving the flu vaccine at a lower rate than the national average in 2022. Hispanic members reported lower than average timely access to appointments and health care.
Overall, American Indian and Alaska Native MA enrollees had scores below the national average on 14 clinical care measures, similar to the national average on eight measures and above the national average on two measures.
Asian American and Native Hawaiian and other Pacific Islander members had scores below the national average on four clinical care measures, similar to the national average for 18 measures and above the national average for 15 measures.
Black MA enrollees reported scores below the national average on 15 clinical care measures, similar to the national average on 19 measures and above the national average on three measures.
Hispanic MA enrollees had scores below the national average on nine clinical care measures, similar to the national average on 20, and above the national average on eight measures.
White MA enrollees had scores similar to the national average on 34 clinical care measures and above the national average on three measures.
The report noted several specific areas where MA plans can focus improvement efforts, including:2
- Prevention and screening for cancers
- Diabetes care outcomes
- Treatment for respiratory and cardiovascular conditions.
Meanwhile, a separate report shows additional opportunities for MA to address gaps in health care quality by addressing social determinants of health, as different SDOH can have different effects on health care utilization, quality and outcomes.3 For example, social isolation and limited access to transportation lead to both poor care quality and high acute care utilization, the report found.
Researchers from Humana and experts from the University of California at San Diego looked at survey data from MA beneficiaries with type 2 diabetes and found 56.9% reported at least one SDOH.4 This is greater than the overall proportion of MA beneficiaries who reported at least one SDOH, which was 49.3 %.
The reported social determinants had different effects on health. For example, loneliness, lack of transportation, utility insecurity and housing insecurity were associated with lower adherence to diabetes medication. Loneliness and lack of transportation were also associated with greater use of acute care services, as was food insecurity.
The most commonly reported SDOH were:
- Financial strain at 73.6%
- Food insecurity at 47.5%
- Poor housing quality at 39.1%.
MA plans and other stakeholders may be able to use information on the health care impacts of SDOH to prioritize interventions, the researchers suggest.
“Community-based organizations and health systems can coordinate activities and cross-sector communication to expand opportunities for community members to reduce [health-related social needs] and increase opportunities for healthy lifestyles,” the researchers said.
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- Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex. CMS. April 2023. https://www.cms.gov/files/document/disparities-health-care-medicare-advantage-race-ethnicity-and-sex.pdf-0
- Wilson, R. Where Medicare Advantage Plans Can Address Disparities, Per CMS. Becker’s Payer Issues. April 19, 2023. https://www.beckerspayer.com/payer/where-medicare-advantage-plans-can-address-disparities-per-cms.html
- Heath, S. Which Social Determinants of Health Lead to Low Care Quality? Patient Engagement HIT. April 24, 2023. https://patientengagementhit.com/news/which-social-determinants-of-health-lead-to-low-care-quality
- Ryan, J., Franklin, S., Canterberry, M., et al. Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes. JAMA Network Open. April 21, 2023. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2804099