Incentivizing Excellent Care to At-Risk Groups with a Health Equity Summary Score
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RAND Corporation, Santa Monica, CA, USA; 2RAND Corporation, Pittsburgh, CA, USA; 3Centers for Medicare & Medicaid Services, Baltimore, MD, USA; 4National Committee for Quality Assurance, Washington, DC, USA.
BACKGROUND: Social risk factors (SRFs) such as minority race-and-ethnicity or low income are associated with quality-of-care, health, and healthcare outcomes. Organizations might prioritize improving care for easier-totreat groups over those with SRFs, but measuring, reporting, and further incentivizing quality-of-care for SRF groups may improve their care. OBJECTIVE: To develop, as a proof-of-concept, a Health Equity Summary Score (HESS): a succinct, easy-tounderstand score that could be used to promote highquality care to those with SRFs in Medicare Advantage (MA) health plans, which provide care for almost twenty million older and disabled Americans and collect extensive quality measure and SRF data. DESIGN: We estimated, standardized, and combined performance scores for two sets of quality measures for enrollees in 2013–2016 MA health plans, considering both current levels of care, within-plan improvement, and nationally benchmarked improvement for those with SRFs (specifically, racial-and-ethnic minority status and dual-eligibility for Medicare and Medicaid). PARTICIPANTS: All MA plans with publicly reported quality scores and 500 or more 2016 enrollees. MAIN MEASURES: Publicly reported clinical quality and patient experience measures. KEY RESULTS: Almost 90% of plans measured for MA Star Ratings received a HESS; plans serving few patients with SRFs were excluded. The summary score was moderately positively correlated with publicly reported overall Star Ratings (r = 0.66–0.67). High-scoring plans typically had sizable enrollment of both racial-and-ethnic minorities (38–42%) and dually eligible beneficiaries (29–38%). CONCLUSIONS: We demonstrated the feasibility of developing and estimating a HESS that is intended to promote and incentivize excellent care for racial-and-ethnic minorities and dually eligible MA enrollees. The HESS measures SRF-specific performance and does not simply duplicate overall plan Star Ratings. It also identifies plans that provide excellent care to large numbers of those with SRFs. Our methodology could be extended to other SRFs, quality measures, and settings. Prior Presentations This work has not been previously presented. Received June 3, 2019 Revised September 12, 2019 Accepted October 9, 2019
KEY WORDS: disparities; social risk factors; quality-of-care; public reporting; Medicare Advantage health plans. J Gen Intern Med DOI: 10.1007/s11606-019-05473-x © Society of General Internal Medicine 2019
INTRODUCTION
Patients with social risk factors (SRFs)—sometimes called social determinants of health [1]—(e.g., patients with low income and racial-and-ethnic minorities) have less access to material and social resources and lower status than moreadvantaged patients, leading to worse healthcare outcomes, including hospital readmission [2–5] and in-hospital mortality [6–8], independe
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