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Study: More Data Collection Needed to Improve Medicare's Racial Gaps

By Libby George, CQ Staff

October 24, 2006 -- Racial disparities in outcome measures linked to some of the deadliest and costliest diseases, including diabetes and heart disease, are prevalent for patients in Medicare managed care plans, according to a new study published in the Journal of the American Medical Association.

The study also found that the disparities between black and white patients cannot be attributed to high- or low-performing health plans or specific regions of the country.

As the first study to examine outcome measures based on race, rather than the quality or types of care received, the Harvard and Brown University findings could have a significant impact on future reporting policies and treatment plans.

Lead author Dr. Amal Trivedi, an assistant professor of community health at Brown Medical School, said the findings have important implications for health care plans in America.

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

Co-author Dr. John Ayanian, an associate professor of medicine and health care policy at Harvard Medical School, said the study also highlights the need for more health plans to collect data on patients' racial and ethnic backgrounds.

"We can only improve care if we have good measures of current care," Ayanian said.

The Centers for Medicare and Medicaid Services currently collects racial and ethnic data on patients, but most health plans do not.

Additionally, all health care plans participating in Medicare have been required to report on the quality of care using specific performance measures since 1997.

The doctors used that data from enrollees in 151 health plans for their study.

According to the study, any number of factors, from the communication between doctors and patients to different lifestyle and diet habits, could contribute to disparities. But without further data, it would be difficult to pinpoint a cause—and therefore difficult to determine how plans can improve treatment.

Peter Bach, a senior adviser at CMS, said the study shows that the government is working to improve care and close the outcome gaps for those of different racial backgrounds.

"The fact that the plans have these sorts of quality measures in place . . . is really a sign that they're moving in that direction, that we're getting there," Bach said.

He added that the study "begs the question of what barriers blacks and whites face in managing the conditions."

"It tells us where we need to focus, and it's exactly where we're trying to focus," Bach said.

The study measured four so-called "outcome measures" for diabetes, hypertension, and heart disease, which are prevalent among Medicare beneficiaries of all backgrounds.

While the measures are not health outcome measures—things that affect a patient's quality of life or longevity—they are intermediate or surrogate measures of disease outcome, Bach said. They include: control of blood sugar and cholesterol among enrollees with diabetes; blood pressure control among enrollees with hypertension, and cholesterol control among enrollees after suffering a heart attack or undergoing heart surgery.

Bach pointed out that since these diseases are also among the costliest to treat, it is also in the government's financial interest to improve outcome measures for all patients. And because the delivery of preventive services is similar within the plans for blacks and whites, the next step for CMS will be examining what barriers blacks and whites face in managing the conditions, Bach said.

"It just means that we have more work to do," Bach said. "What do we need to do to help black Americans in managed care get what they need?"

Susan Pisano, a spokeswoman for America's Health Insurance Plans (AHIP), a trade group representing health insurers, said the issue of addressing health care disparities "is a top priority for many AHIP member health insurance plans and for the association."

AHIP, she said, has taken a multi-pronged approach to the problem, including encouraging data collection on race and ethnicity of members as a necessary foundation for quality improvement, fostering training and education on cultural competency, and publishing an online guide to creating a culture of cultural competency within organizations. AHIP also is establishing a clearinghouse of approaches that have worked to reduce gaps in quality of care, Pisano said.

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