Racial disparities high in Medicare plans

October 24, 2006

BOSTON -- Numerous studies show the African-Americans receive worse quality of care relative to white Americans across a broad array of medical conditions--disparities that can significantly harm patients or reduce quality of life. A new study from Harvard Medical School and Brown Medical School shows that such disparities in care cannot simply be attributed to low-performing health plans. The research, published in the Oct. 25 Journal of the American Medical Association, shows that high-performing plans and low-performing health plans, based on four key health measures, have comparable levels of disparities in these measures while serving Medicare patients.

"Across Medicare health plans, better overall quality is not consistently associated with smaller racial disparities on four key outcome measures for enrollees with diabetes, hypertension, or heart disease," says John Ayanian, MD, MPP, associate professor of health care policy and of medicine at Harvard Medical School (HMS) and Brigham and Women's Hospital.

Ayanian, Amal Trivedi, MD, MPH, formerly of the Department of Health Care Policy at HMS and now an assistant professor of community health at Brown Medical School, and colleagues found only one health plan in a sample of 151 that had both high overall quality and low racial disparity on more than one of four outcome measures examined.

Since 1997, all health plans participating in Medicare have been mandated to report on quality of care using Health Plan Employer and Data Information Set (HEDIS) performance measures developed by the National Committee for Quality Assurance. The authors obtained HEDIS data for Medicare managed care plans, containing more than 431,000 observations from enrollees in 151 health plans.

For the four HEDIS outcome measures the authors examined, clinical performance was approximately 7 to 14 percent lower for black enrollees than white enrollees. More than 70 percent of the racial disparity on each measure was attributable to different outcomes within the same health plans for white and black enrollees, not a disproportionate enrollment of blacks in lower-performing plans.

"This study indicates that most health plans have substantial opportunities to improve their outcomes for African-American enrollees on these measures," says Trivedi.

The authors examined data for individuals eligible for at least one of four HEDIS outcome indicators: control of blood sugar and cholesterol among enrollees with diabetes, blood pressure control among enrollees with hypertension, and cholesterol control among enrollees following a heart attack or heart surgery.

For all measures, the difference between the top and bottom ranked health plan in overall quality ranged from 35 (for blood pressure control of hypertension) to 70 percent (for blood sugar control of diabetes). Although a few plans did not have significant disparity, some plans had racial differences of more than 20 percent.

"This shows that racial disparities in these important outcome measures are widespread and not limited to any one region or subset of poorly performing health plans," says Ayanian.

Achieving equity may be more difficult for outcome measures, which often require sustained access and adherence to drug therapy, an ongoing relationship with a health care provider, lifestyle modifications, and attention to social determinants of health, than for measures of processes of care that require simpler actions, such as a single annual blood test.

"Our findings suggest that nearly all Medicare health plans will need to develop specific programs to improve equity on at least three of the four clinical outcome measures we studied," says Trivedi. "The federal government requires health plans to measure and report overall quality on these clinical indicators. We recommend that health plans assess disparities in clinical performance measures as part of a broad strategy to eliminate racial and ethnic disparities in quality of care."

Many health plans do not collect data on the race or ethnicity of enrollees, but without such data, health care organizations will be unable to detect systematic racial or ethnic disparities among patients or develop and evaluate interventions to eliminate disparities.
-end-
EMBARGOED FOR RELEASE: Tuesday, Oct. 24, 2006, 4 pm U.S. EST

This work was supported by an institutional National Research Service Award and grant from the Agency for Healthcare Research and Quality; an institutional National Research Service Award from the Health Resources and Services Administration; the Primary Care Research Fund at Brigham and Women's Hospital; and a Bridge Award from Harvard Medial School.

HARVARD MEDICAL SCHOOL (http://hms.harvard.edu/)
Harvard Medical School has more than 7,000 full-time faculty working in eight academic departments based at the School's Boston quadrangle or in one of 47 academic departments at 18 Harvard teaching hospitals and research institutes. Those Harvard hospitals and research institutions include Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, Cambridge Health Alliance, The CBR Institute for Biomedical Research, Children's Hospital Boston, Dana-Farber Cancer Institute, Forsyth Institute, Harvard Pilgrim Health Care, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Massachusetts Mental Health Center, McLean Hospital, Mount Auburn Hospital, Schepens Eye Research Institute, Spaulding Rehabilitation Hospital, VA Boston Healthcare System.

Harvard Medical School

Related Blood Sugar Articles from Brightsurf:

Does high blood sugar worsen COVID-19 outcomes?
Preliminary observations of COVID-19 patients with diabetes inspired an algorithm for glucose monitoring that's suspected to help combat the virus' serious complications.

Cinnamon may improve blood sugar control in people with prediabetes
Cinnamon improves blood sugar control in people with prediabetes and could slow the progression to type 2 diabetes, according to a new study published in the Journal of the Endocrine Society.

Laser-welded sugar: Sweet way to 3D-print blood vessels
Rice University bioengineers have shown they can keep densely packed cells alive in lab-grown tissues by creating complex networks of branching blood vessels from templates of 3D-printed sugar.

Experimental two-in-one shot may give diabetics a better way to control their blood sugar
Amylin plays a synergistic role with insulin to control blood sugar levels after eating in a way that is more effective than insulin alone and mimics what occurs naturally with a meal.

For people with diabetes and COVID-19, blood sugar control is key
A study reported in the journal Cell Metabolism on April 30 adds to the evidence that people with type 2 diabetes (T2D) are at greater risk of a poor outcome should they become infected with the virus that causes COVID-19.

Getting off of the blood sugar roller coaster
For the 250,000 Canadians living with type 1 diabetes, the days of desperately trying to keep their blood sugar stable are coming to an end.

Need to control blood sugar? There's a drink for that, says UBC prof
With more people with diabetes and pre-diabetes looking for novel strategies to help control blood sugar, new research from UBC's Okanagan campus suggests that ketone monoester drinks--a popular new food supplement--may help do exactly that.

People with type 1 diabetes struggle with blood sugar control despite CGMs
Some continuous glucose monitoring (CGM) alarm features and settings may achieve better blood sugar control for people with type 1 diabetes, according to a study published in the Journal of the Endocrine Society.

Diabetes advances poised to help manage blood sugar after meals
Mealtimes can become a difficult experience for individuals with diabetes.

Lipid produced by organism helps control blood sugar
Blood sugar levels in obese mice were controlled more efficiently when the mice were challenged with a glucose overload and treated with 12-HEPE, a lipid produced in response to cold by brown adipose tissue.

Read More: Blood Sugar News and Blood Sugar Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.