Disparities/Minority Health

Racial disparities in care vary widely among Medicare health plans and are only weakly correlated with overall quality of care

Few public reports about the quality of health care organizations have also assessed the equity of care provided by those organizations. A new study shows that in Medicare health plans, racial disparities in care vary widely and are only weakly correlated with the overall quality of care. Therefore, plan-specific performance reports of racial disparities in health outcome measures would provide useful information not currently conveyed by standard Health Plan Employer Data and Information Set (HEDIS) reports, conclude the researchers.

They used four HEDIS outcome measures to assess variations among 151 Medicare health plans in overall quality and racial disparity from 2002 to 2004. The outcome measures included HbA1c (blood glucose measure) of less than 9.5 percent or less than 9 percent for enrollees with diabetes; low-density lipoprotein cholesterol level of less than 130 mg/dL for enrollees with diabetes or after a coronary event; and blood pressure of less than 140/90 mm Hg for hypertensive enrollees.

Health plans varied substantially in both overall quality and racial disparity on each of the four outcome measures, and quality and racial disparity were not correlated. Overall, 21 to 41 percent of enrollees did not achieve the relatively liberal goals for blood pressure, glucose, and cholesterol control. Clinical performance on these measures was 7 to 14 percent lower for black enrollees compared with their white counterparts. For each measure, more than 70 percent of this disparity was due to different outcomes for black and white individuals enrolled in the same health plan rather than selection of black enrollees into lower-performing plans. While some plans did not show significant disparities between white and black enrollees, others showed disparities exceeding 20 percent on these measures. The study was supported in part by the Agency for Healthcare Research and Quality (HS10803 and HS00020).

See "Relationship between quality of care and racial disparities in Medicare health plans," by Amal N. Trivedi, M.D., M.P.H., Alan M. Zaslavsky, Ph.D., Eric C. Schneider, M.D., M.Sc., and John Z. Ayanian, M.D., M.P.P., in the October 25, 2006, Journal of the American Medical Association 296(16), pp. 1998-2004.

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