- Despite a growing industry focus on addressing the socioeconomic determinates of health, population health disparities between ethnic and racial groups persist across a number of chronic and acute care experiences, according to new data from CMS.
Healthcare providers must take on the challenge of addressing minority health disparities and closing gaps in patient experiences and outcomes exacerbated by deeply entrenched social and economic differences.
“At CMS we have an extraordinary opportunity to improve health outcomes for the over 100 million people that we serve every day,” said CMS Administrator Seema Verma in a blog post noting that April is National Minority Health Month. “Our primary mission is to make healthcare accessible and affordable for all Americans.”
“During this important month, we continue our efforts to raise awareness about disparities, and provide tools and resources to support actions to address them.”
In support of that mission, CMS has released two new reports, one focused on gender disparities and the other on racial and ethnic outcomes, highlighting the need for the healthcare system to continue making progress towards an equitable and high-quality delivery system.
The data, based on the 2015 Medicare CAHPS survey, reveals that minority groups tend to have worse patient experiences than their white counterparts across a broad range of metrics, with male Asian or Pacific Islanders (API) experiencing the most extreme differences.
Male API patients reported worse experiences than white male patients on seven out of eight core metrics.
The metrics include timely access to appointments, patient-provider communication, care coordination, access and education about prescription drugs, and offers of an annual flu vaccine.
Black male patients scored more poorly than whites on two metrics, while Hispanic males had less satisfactory experiences than white men in three areas, including getting needed care and receiving care coordination services.
Female minority patients also struggle with access to appointments, annual vaccines, care coordination, and prescription drugs.
Female Asian and Pacific Islanders were ten percent less likely than white women to report satisfaction with how long it takes to get an appointment with a provider, while black and Hispanic women also indicated lower satisfaction rates for this experience metric.
Care coordination services for minority women were also uniformly below the bar set by white female patients, and non-white women were also less likely to report adequate access to prescription drug therapies.
Disparities in care persist in the realm of clinical outcomes, as well, although some minority groups do receive better care than white patients in certain domains.
API and Hispanic men women, for example, are significantly more likely than black or white men and women to receive colorectal cancer screenings, and are slightly more likely to have had an HbA1c test, diabetic eye exam, and diabetic kidney disease screening within one year of the survey.
Overall, diabetic API patients were more likely than other ethnic groups to report that their blood sugar was under control. Black men and women were the least likely to have an HbA1c level of 9 percent or less, with just 70 percent of black women and 68 percent of black men meeting the threshold.
Minority health disparities were also present across a number of other chronic diseases, including arthritic, COPD, and depression.
Other notable findings from the reports include:
- Hispanic men and women with chronic renal failure are between 7 and 8 percent less likely than white patients to avoid potentially harmful drug-disease interactions.
- Just 41 percent of black women and 38.9 percent of black men remain on antidepressants for 180 days after a new diagnosis of major depressions. 57 percent of white women and 54.7 percent of white men report the same.
- When divided solely by gender, women tend to fare better than men with certain chronic disease screenings, including BMI assessment, diabetic eye exams, and blood sugar testing.
- API, black, and Hispanic men are between 5 and 6 percent less likely than white men to receive a prescription to manage rheumatoid arthritis. Minority women fared better, reporting rates within several points of white women.
- Hispanic men and women reported the lowest levels of pharmacotherapy management for COPD after an acute inpatient stay or emergency department encounter for the respiratory disease. API men and women, however, both outperformed their white peers, and women in general reported higher COPD management rates than men.
- Elderly women with dementia were nearly ten percent less likely than men to avoid potentially harmful drug-disease interactions. Only 47 percent of women with dementia were not dispensed a potentially harmful medication, compared to 56.1 percent of men.
- Black men and women are significantly less likely than other groups to receive adult BMI assessments. Compared to the 95 percent of Asian or Pacific Islander patients receiving this service, just 79.9 percent of black women and 77.2 percent of black men were screened for obesity.
“This tremendous research can only point out the problems,” Verma acknowledged. “We need healthcare professionals, stakeholder organizations, researchers, and community groups to use these CMS reports, along with our other tools and resources, to develop interventions for racially and ethnically diverse Medicare beneficiaries.”
In 2015, the agency also released the first iteration of its Equity Plan for Improving Quality in Medicare, which formed the foundation for a three-part path to closing socioeconomic disparity gaps. As part of the overarching plan to improve population health, CMS will focus on increasing understanding of health disparities, developing scalable solutions, and evaluating the impact of ongoing efforts, officials said in November of 2016.
“Through transparency, flexibility, and innovation, we will use every available tool to improve the Medicare program and promote the availability of high value and efficiently-provided care for all beneficiaries,” Verma added.
“We do this by working together with plans, providers and the patients we serve to find ways to reduce the disparities highlighted in these reports and find effective health solutions that work for all communities and all Americans.”