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PCPs should be more mindful of racial gaps in preventive care services

PCPs should be more aware of current racial and ethnic disparities in the receipt of preventive health care, and CMS should consider developing a separate measure of equity to encourage health plans to close such gaps, according to data published in Preventing Chronic Disease.

“The Affordable Care Act increased access to preventive care in private health insurance plans and in the Medicare program by eliminating patient cost sharing for some services,” Daniel H. Jung, BS, of the University of Wisconsin School of Medicine and Public Health, and colleagues wrote. “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…. Using data from 2006 [researchers] 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.”

In 2012, CMS debuted the Quality Bonus Payment Demonstration, a pay-for-performance program, into Medicare Advantage plans. To analyze whether incentives in the pay-for-performance program affected reported racial disparities in the receipt of preventive care, the researchers focused on three areas — reducing the risk for falling, improving bladder control and monitoring physical activity.

They 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 provider guidance or treatment to reduce the risk for one of the three health areas among patients reporting those problems. The researchers used logistic regression, stratified by health care plan, to determine racial gaps in preventive health care received before and after the introduction of the pay-for-performance program.

According to the researchers, similar differences in the receipt of preventive care persisted across racial lines both before and after the program’s introduction in 2012. Blacks and Asians were less likely than whites to receive advice to improve bladder control, but more likely to receive advice for reducing the risk for falling and to improve their physical activity. Meanwhile, Hispanics were more likely to receive advice about all three health issues than whites. Following the introduction of pay-for-performance, the gap decreased between Hispanics and whites for improving bladder incontinence and monitoring physical activity, but increased between blacks and whites for physical activity.

“After the introduction of [pay-for-performance], the gap increased between black and white seniors in care to monitor physical activity and was unchanged between Asians and whites,” Jung and colleagues wrote. “Although the gap between Hispanics and whites decreased on measures for urinary incontinence and physical activity, bivariate results indicated that this was due to a decrease in receipt of care by Hispanics. These results highlight the importance of tracking the impact of financial incentives such as [pay-for-performance] on care delivery to monitor both intended and unintended consequences.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.