Finding Solutions for Disparities Associated with Star Ratings

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Established by the Centers for Medicare & Medicaid Services (CMS), Star Ratings system for Medicare Parts C&D (Star Ratings, hereafter) is a health plan quality reporting system with associated bonus payments and enrollment incentives for health plans since 2012. Researchers have reported the disparity implications of Star Ratings: e.g., racial/ethnic minorities are more likely to be excluded from measure calculation for diabetes adherence than non-Hispanic whites, thus minorities may be more likely to be excluded from quality improvement initiations for this measure, potentially worsening disparities in health. A critical barrier for resolving such disparities is that comprehensive policy recommendation related to effects of Star Ratings on racial/ethnic disparities is not available. The goals of this project are to ensure that Star Ratings include a set of measures that address disparities in measure calculation, and to evaluate the effects of Star Ratings bonus payments on reducing racial/ethnic disparities in medication utilization. Our strategies are to (1) add to Star Ratings medication utilization measures selected from Pharmacy Quality Alliance measure concept inventory (PMCI), and other commonly used medication utilization (CUMU) measures (Star Plus, hereafter), and (2) compare racial/ethnic disparities in medication utilization before and after the implementation of bonus payments, and between counties with “double bonuses” and those with regular bonuses. A project focusing on only medication utilization measures in Star Ratings is warranted because these measures account for a high percentage in Star Ratings scores (45% in Part D in 2013) and their correlation with other measures is only moderate. Bonus payments are associated with improved plan benefit structure, which may reduce racial/ethnic disparities in medication utilization. In the prior grant period we found that selecting appropriate medication utilization measures may resolve racial/ethnic disparities associated with a Medicare Part D policy. Our objective of this continuation project is to conduct an analysis of Medicare Parts A/B/D data (2010-2015), linked to Area Health Resources Files, Orange Book Data Files, and CMS data on double/regular-bonus counties. We will also conduct disease-specific analysis. Aim 1: Test the hypothesis that using the medication utilization measures in current Star Ratings negatively affects the health of racial/ethnic minorities. Aim 2: Test the hypothesis that using Star Plus can lead to a reduction in racial/ethnic disparities associated with Star Ratings. Aim 3: Test the hypothesis that the Star Ratings bonus payments are associated with reduction in racial/ethnic disparities in medication utilization. Our expected outcome is to provide policy recommendations to resolve important disparity issues in Star Ratings among diverse older adults. Impact: This project will help to align disparity reduction goals with rapidly-proliferating pay-for-performance and public-reporting initiatives. This project is responsive to the National Institute on Aging's mission-driven strategic goal to “understand health disparities and develop strategies to improve the health status of older adults in diverse populations.”