Disparities in Health Measures By Race and Ethnicity Among Beneficiaries in Medicare Advantage: A Review of the Literature

Over the past decade, Medicare Advantage enrollment has steadily increased, especially rapidly among people of color. Currently, just over half of eligible Medicare beneficiaries are enrolled in a Medicare Advantage plan, with black, Hispanic, and Asian Pacific Islander beneficiaries participating at higher rates than white beneficiaries. As of 2021, 59% of Black Medicare beneficiaries, 67% of Hispanic beneficiaries, and 55% of Asian and Pacific Islander beneficiaries were enrolled in a Medicare Advantage plan, compared to 43% are enrolled in a Medicare Advantage plan.

Are there racial/ethnic disparities in quality of care and health care experiences among Medicare Advantage enrollees, despite relatively higher rates of Medicare Advantage enrollment among people of color compared to white beneficiaries? Little is known about it.

KFF's previous review of 62 studies compared Medicare Advantage and traditional Medicare on measures of beneficiary experience and quality of care. Previous reviews have found that relatively few studies have examined beneficiary differences by race and ethnicity between Medicare Advantage and traditional Medicare, and therefore people of color across the two sources of Medicare coverage. It was difficult to compare experiences.

This review examines differences in measures of quality of care and beneficiary experience between people of color and white Medicare Advantage enrollees or the total Medicare Advantage population in Medicare Advantage plans. This analysis synthesized results from 20 identified studies published over a five-year period from January 2018 to April 2023. These 20 studies collectively reported 46 different measures of quality of care and beneficiary experience, but not all studies examined all groups or included groups. I haven't investigated either. All measures. All differences described in this report are statistically significant unless otherwise noted (e.g., results reported as similar). Most of the studies (17 of 20) controlled for differences in enrollees' health status or other demographic characteristics in some way. (See Methods for additional information on the criteria used to select studies, Appendix Table 1 for a complete list of indicators included in these studies, and Appendix Table 2 for a detailed description of each study) Please refer to.)

Although the scope of this review is limited to Medicare Advantage enrollees, the racial and ethnic disparities in quality of care and beneficiaries described in this report reflect disparities in medical care and health care. doing. traditional medicarethe entire Medicare population, and more broadly the U.S. adult population.

Important points

Black registrants: Black Medicare Advantage enrollees fared less favorably than white Medicare Advantage enrollees on more than half (24) of the 46 measures examined for this group in 19 studies. Results were better for eight scales and similar for five scales, but were inconsistent across studies for two scales, and differences were not substantively significant for seven scales, the study authors said. . for example:

• Use of preventive services: A higher proportion of black Medicare Advantage enrollees than white enrollees received breast cancer screenings, colorectal cancer screenings, and pap smears, but black enrollees had lower rates of prostate cancer screening and influenza vaccination. It was low.
• hospitalization: A higher proportion of Medicare Advantage enrollees than whites are hospitalized for outpatient treatment-sensitive conditions (a measure of preventable hospitalization); The patient was readmitted to the hospital within days.
• mental health: A lower proportion of black enrollees than whites had depression, were treated with antidepressants, and remained on the medication for at least 12 weeks.
• thoughtful experience: A lower proportion of black Medicare Advantage enrollees than whites reported seeing a specialist in the past year, but similar proportions of black and white enrollees received well-coordinated care and reported seeing a specialist in the past year. Reported that he obtained the necessary prescription medication.
• Plan evaluation: A lower percentage of black enrollees than whites were enrolled in highly rated Medicare Advantage plans.

Hispanic registrants: On more than one-third (16) of the 42 measures examined among Hispanic Medicare Advantage enrollees in 17 studies, Hispanic Medicare Advantage enrollees fared less favorably than whites. Ta. Findings were more favorable for eight scales, similar for five scales, but inconsistent across studies for three scales, and for 10 scales, the study authors found that the differences were virtually non-significant. He said it was not. for example:

• Use of preventive services:Among Medicare Advantage enrollees, a higher proportion of Hispanics than whites reported having received breast cancer screening, but a lower proportion had received an influenza vaccine.
• disease management:A lower proportion of Hispanics than whites among Medicare Advantage enrollees receive follow-up care after visiting the emergency department for certain conditions, including mental health and a range of high-risk chronic conditions.
• thoughtful experience: A lower percentage of Hispanics in Medicare Advantage enrollees than whites reported that appointments and care were readily available.
• hospitalization:Hispanic and white enrollees had similar rates of readmissions and hospitalizations for outpatient treatment-sensitive conditions.
• Plan evaluation: A lower percentage of Hispanic enrollees than whites were enrolled in highly rated Medicare Advantage plans.

Registrants in Asia and the Pacific Islands: Asian and Pacific Islander enrollees performed more unfavorably than white enrollees on 9 of 36 measures in 13 studies. The findings were better on 7 scales, similar on 7 scales, but inconsistent across studies on 3 scales, and for 10 scales, the study authors found that the differences were not substantively significant. I said no. for example:

• preventive services:A greater proportion of Asian and Pacific Islander residents had received an influenza vaccine than white enrollees, and a similar proportion had received colorectal cancer screening.
• disease management: A higher proportion of Asian and Pacific Islander enrollees than white enrollees receive statin therapy as part of their diabetes treatment, but a lower proportion of Asian and Pacific Islander enrollees have alcohol or other drug dependence. Rates of new episodes of dependence and initiation of treatment for alcohol or other drugs were low.
• hospitalization: Asian and Pacific Islander enrollees and white enrollees had similar rates of hospitalization for outpatient treatment-sensitive conditions.

American Indian and Alaska Native enrollees: Less than half of the studies identified in this review (9 of 20) presented findings among American Indian and Alaska Native Medicare Advantage enrollees, and overall, Black (46) , included fewer measures (25) than studies of Hispanics (42). or Asian and Pacific Islander (36) Medicare Advantage enrollees. The findings were less favorable for American Indian and Alaska Native enrollees than White Medicare Advantage enrollees on seven measures, more favorable on four measures, similar on 12 measures, and less favorable than White Medicare Advantage enrollees on one measure. There was no consistency across studies, and for one measure, the study authors said the difference was not substantial. for example:

• preventive services: A greater proportion of American Indian and Alaska Native enrollees had received breast cancer screening than white enrollees, and a similar proportion had received an influenza vaccine.
• disease management: A greater proportion of American Indian and Alaska Native enrollees had their blood sugar and blood pressure controlled as part of their diabetes treatment than white enrollees.

research gap The data present challenges in understanding the experiences of specific racial and ethnic groups with Medicare Advantage plans.

• Medicare Advantage insurers do not report data on prior authorization or denial rates by race or ethnicity, or the use of supplemental benefits in the Medicare Advantage population as a whole or by race or ethnicity.
• None of the studies examined outcomes of care such as mortality or nosocomial infections.
• No studies have examined postacute care utilization among Medicare Advantage enrollees by race or ethnicity.
• None of the studies reported findings on Native Hawaiians and other Pacific Islanders separately from other groups, and neither did they report findings on Native Hawaiians and other Pacific Islanders separately from other groups, nor did they report findings on Native Hawaiians and other Pacific Islanders separately from those who identify as two or more racial or ethnic groups and white enrollees. There are also no studies comparing measures of quality of care or beneficiary experience between the two groups.
• None of the studies presented stratified estimates for all racial and ethnic groups listed. Current federal minimum standards. Studies also differed in how they identified race and ethnicity, with some using self-identified data and others using imputed race/ethnicity data.
• Few studies have stratified racial/ethnic findings among Medicare Advantage enrollees by gender or rural residence.
• Survey results for Medicare Advantage enrollees stratified by race/ethnicity and dual eligibility status, despite people of color making up a disproportionate share of dual-eligible Medicare Advantage enrollees There are no studies that have done so.

Because more than half of Blacks, Hispanics, and Asians and Pacific Islanders are enrolled in Medicare Advantage plans, the studies in this review examine how well Medicare Advantage plans serve people of color compared to white enrollees. Provides insight into what is being offered. However, relatively few studies and research gaps exist to help beneficiaries make coverage decisions and to help policymakers understand how best to make Medicare Advantage work for the general public and people of color. We present challenges when doing so.