Differences in Receipt of Three Preventive Health Care Services by Race/Ethnicity in Medicare Advantage Plans: Tracking the Impact of Pay for Performance, 2010 and 2013

Daniel H Jung,Thomas R Oliver,Eva H Dugoff,Maureen Smith,Mari Palta

doi:10.5888/pcd13.160047

Abstract

IntroductionIn 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-for-performance (P4P) program, into Medicare Advantage plans. Previous studies documented racial/ethnic disparities in receipt of care among participants in these plans. The objective of this study was to determine whether P4P incentives have affected these disparities in Medicare Advantage plans.MethodsWe studied 411 Medicare Advantage health plans that participated in the Medicare Health Outcome Survey in 2010 and 2013. Preventive health care was defined as self-reported receipt of health care provider communication or treatment to reduce risk of falling, improve bladder control, and monitor physical activity among individuals reporting these problems. Logistic regression stratified by health care plan was used to examine racial/ethnic disparities in receipt of preventive health care before and after the introduction of the P4P program in 2012.ResultsWe found similar racial/ethnic differences in receipt of preventive health care before and after the introduction of P4P. Blacks and Asians were less likely than whites to receive advice to improve bladder control and more likely to receive advice to reduce risk of falling and improve physical activity. Hispanics were more likely to report receiving advice about all 3 health issues than whites. After the introduction of P4P, the gap decreased between Hispanics and whites for improving bladder control and monitoring physical activity and increased between blacks and whites for monitoring physical activity.ConclusionRacial/ethnic differences in receipt of preventive health care are not always in the expected direction. CMS should consider developing a separate measure of equity in preventive health care services to encourage health plans to reduce gaps among racial/ethnic groups in receiving preventive care services.

Highlights

In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-forperformance (P4P) program, into Medicare Advantage plans
CMS should consider developing a separate measure of equity in preventive health care services to encourage health plans to reduce gaps among racial/ethnic groups in receiving preventive care services
We compared data on Medicare Advantage plan participants enrolled in 411 plans who responded to the Medicare Health Outcomes Survey in 2010 and 2013

Summary

Introduction

In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Quality Bonus Payment Demonstration, a pay-forperformance (P4P) program, into Medicare Advantage plans. Few studies have examined the delivery of preventive care in Medicare Advantage plans, which provide health care coverage to 31% of Medicare beneficiaries through private health plans [2]. Using data from 2006, Ng and colleagues found significant differences in the delivery of preventive care services between black and white patients [4] They reported that black patients were more likely to receive care from their health care provider to reduce falls, but white patients were more likely to receive osteoporosis care. Race was not associated with receiving urinary incontinence care or physical activity advice

Objectives

Methods

Results

Conclusion