Connecting the Dots: The Impact of Health Disparities on Star Ratings

Healthcare quality improvement efforts have traditionally looked at healthcare policy, access to care, and the practice of medicine as some of the key drivers to improve clinical quality performance.  Significant advances have been made in recent years to expand and enhance access to high-quality care, to ensure adherence to evidence-based clinical practice guidelines, and to support standardized care pathways while still incorporating patients’ and practitioners’ decisions and preferences into the care planning process.  But as quality improvement efforts in Medicare Advantage have matured, we’ve hit a performance plateau.  Star Ratings measure performance has declined or stagnated on numerous Medicare Advantage quality measures:

stars-measures-large-image

As MA plans continue efforts to improve performance on these (and other) Star Ratings measures, the next phase of quality improvement must tackle the often-difficult task of improving health among unengaged, clinically complex, and socioeconomically and socially disadvantaged beneficiaries.  The health disparities among these populations are well-documented, and frequently manifest themselves in Star Ratings performance.

How can health disparities show up on a health plan’s Star Ratings radar screen?

  • Low-income disparities often manifest themselves via bad addresses and phone numbers, which prevent important information and education from reaching beneficiaries.
  • Limited English proficiency, low health literacy, and economic, lifestyle or other health disparities often manifest themselves through unresponsiveness, non-adherence to medications, uncontrolled disease, and absence of visits with appropriate providers. Often these disparities trend by zip codes, street addresses, etc.
  • Race, ethnicity, age and many other health disparities may manifest themselves through persistent noncompliance on HEDIS screening and outcomes measures, as well as medication adherence measures.
  • When Star Ratings are reported by provider, many health disparities manifest themselves through a provider’s low Star Rating.

Research demonstrates that improving population health, as measured by Star Ratings in MA, will require investments into broader approaches that address demographic, social, economic, and environmental factors which are often symptoms of health disparities.  These factors include race, age, language and the broad array of social and lifestyle factors below:

health-disparities-factors

SOURCE: http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/

How can a health plan reduce disparities in a way that simultaneously support Star Ratings where time and resources are often limited?

  • Increase awareness and understanding of disparities, including how disparities manifest themselves in interactions with members, how they are represented within data and why it is important to reduce disparities through our work.
  • Educate all staff on health disparities so that effective decisions and investments can be made to design effective business processes, effectively contract with providers and successfully interact with members based upon data-driven conclusions.
  • Collaborate with providers to understand their challenges (and the challenges of their patients) and resource solutions.
  • Ensure that you have access to the data needed to identify and support health disparities. From language preferences and health literacy barriers to self-care issues such as food and housing security, every member is presents a unique combination of needs that a health plan can support.
  • Keep it REAL. Continue to champion discussions of Race, Ethnicity, Age and Language throughout the organization.
  • Evaluate corporate culture. Ensure that all personnel know how to objectively discuss and address disparities through their work.

By establishing a member-centric culture focused on continuous quality improvement, MA plans can reduce health disparities while simultaneously improving Star Ratings.   To learn more about how GHG can support your organization’s Star Ratings efforts, please contact me at msmith@gormanhealthgroup.com.

 

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There is no time to delay. Your organization needs to identify opportunities to increase your Star Rating, implement an enterprise-level strategy, and carefully monitor your progress over the next plan year.  We can help you every step of the way with our full portfolio of GHG practices, products and services. Visit our website to learn more >>

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