CMS Report Looks at Historical Health Equity Trends for Medicare Advantage Beneficiaries
- January 21, 2022
The Centers for Medicare & Medicaid Services’ Office of Minority Health (CMS OMH) recently released a report analyzing historical trends in inequities by race, ethnicity, sex, and geography among Medicare beneficiaries enrolled in Medicare Advantage (MA) plans nationwide.
CMS OMH has published annual reports since 2015 that highlight inequities in the quality of care delivered to Medicare beneficiaries nationwide, but until now, these annual reports focused only on comparisons within a single year, the agency noted.
The report focuses on a set of patient experience and clinical care measures that are comparable across a ten-year period, and describes inequities that existed in 2009, how those inequities changed over the ten-year period, how scores for each beneficiary group changed over time, and what inequities remained in 2018.
Patient Experience Measures
The report looked at patient experience measures for all racial and ethnic minority groups versus White beneficiaries. In 2009, scores for Asian or Pacific Islander, Black, and Hispanic beneficiaries were lower than scores for White beneficiaries on the measures of Getting Needed Care, Getting Care Quickly, and Customer Service. The score for Asian or Pacific Islander beneficiaries on the Annual Flu Vaccine measure was seven points higher than the score for White beneficiaries, whereas scores for Black and Hispanic beneficiaries on this measure were 16 points lower than the score for White beneficiaries, the report found.
According to the report, scores on Getting Needed Care decreased from 2009 to 2018 at a steeper rate for Asian or Pacific Islander beneficiaries than for White beneficiaries, which “likely reflects a growing inequity.”
For two patient experience measures, scores for Black beneficiaries improved more than scores for White beneficiaries. For the other two patient experience measures, scores for White beneficiaries decreased while scores for Black beneficiaries either increased or remained about the same. This divergence in trends resulted in the elimination of two small-to-moderate inequities and the reduction of two large inequities, the report found.
In addition, CMS found scores for Hispanic beneficiaries on the Annual Flu Vaccine measure increased more than scores for White beneficiaries, resulting in the reduction of an initially large inequity.
Clinical Care Measures
According to the report, in 2009, scores for Asian or Pacific Islander beneficiaries versus White beneficiaries were better on two of the seven clinical care measures, worse for two measures, and similar for the other three measures. In 2018, scores for Asian or Pacific Islander beneficiaries were better than scores for White beneficiaries on four measures and worse on three measures. All in all, scores for Asian or Pacific Islander beneficiaries relative to White beneficiaries were not consistently better or worse, the report said.
For Black beneficiaries, in 2009, scores on five of the seven clinical care measures were worse than for White beneficiaries. Three of these five inequities were large, the report noted. From 2009 to 2018, scores for Black beneficiaries improved for five of the clinical care measures and worsened for two. In three instances, scores for Black beneficiaries improved more than scores for White beneficiaries, resulting in the elimination of an initially large inequity, an initially moderate inequity, and an initially small inequity by 2018.
The report found scores on all seven clinical care measures were worse for Hispanic beneficiaries than for White beneficiaries in 2009. However, large improvements for Hispanic beneficiaries relative to White beneficiaries from 2009 to 2018 resulted in the elimination of inequities on five of the seven clinical care measures, including three for which scores for Hispanic beneficiaries eventually surpassed those for White beneficiaries. For the other two measures, differences between Hispanic and White beneficiaries that existed in 2009 were reduced by about one point each by 2018, according to the report.
Looking at equality trends by sex, the report found that in 2009, differences between male and female beneficiaries on patient experience measures were small and mixed and did not change appreciably over the ten-year timeframe of CMS’ analysis. Female beneficiaries generally had higher scores on the clinical care measures than male beneficiaries.
In addition, the report found that in 2009, scores on one patient experience and all clinical care measures were lower for rural residents than for urban residents.
The report drew several conclusions from the data, including:
- Although substantial reductions occurred in what were very large inequities for Black and Hispanic beneficiaries on the Annual Flu Vaccine measure in 2009, progress still remains to be made as inequities for these groups were not entirely eliminated. There is also still room for improvement on the Getting Care Quickly measure. There was little progress made in the reduction of inequities in patient experience for Hispanic beneficiaries, and scores on Getting Needed Care declined faster for Asian or Pacific Islander beneficiaries than for any other racial or ethnic group. These, too, are areas in need of continued attention, the report said.
- There was substantial improvement for Black and Hispanic beneficiaries in the area of clinical care, both absolutely and relative to White beneficiaries. These trends resulted in a substantial reduction in what were large inequities on almost all clinical care measures analyzed. However, the report noted some large shortfalls that remained in 2018, most notably for Follow-Up After Hospitalization for Mental Illness. On that measure, 2018 scores for Black beneficiaries were still 13–20 points worse than scores for Asian or Pacific Islander, Hispanic, and White beneficiaries.
- Improvements for rural residents on rates of flu vaccination and scores on six of seven HEDIS measures analyzed resulted in the substantial reduction or elimination of what were often large inequities on these measures in 2009.
CMS concluded that further investigation is needed “to understand the reason for the large improvements in care that occurred for Black and Hispanic beneficiaries and for rural residents, since lessons learned from such an investigation could potentially be applied to ensure continued progress toward greater health care equity for all beneficiaries.”