Understanding the Relationship between Medicare Advantage Provider Network Diversity on Health Disparities

项目摘要 黑人和西班牙裔医疗保险受益人在医疗保险优势计划中的注册率更高， 接受较低质量的护理，经历比他们的白色同行更差的结果。这些差距 各计划之间差异显著，有些计划设法为传统上被边缘化的人提供高质量的护理， 人口。目前尚不清楚这些计划的哪些特点有助于降低 黑人和西班牙裔注册者。先前的工作已经确定，黑人和西班牙裔患者往往有更好的 当看到医生和同一种族/民族的其他提供者时，各种情况下的结果。它 目前尚不清楚MA计划的网络在多大程度上包括少数民族医生，以及医生的多样性是否 计划的网络对参加者的健康差距具有下游影响。如果不了解 参加者可以在Medicare Advantage计划中获得不同的提供者，这些差异是 可能会继续。我们的长期目标是确定减少黑人和西班牙裔健康差距的战略 加入Medicare Advantage计划。本申请的目的是开发新的方法， 衡量Medicare Advantage初级保健提供者网络的多样性，并确定网络 多样性是解决健康差距的一个重要因素。我们的核心假设是， 初级保健提供者网络将为黑人和西班牙裔注册者提供更高质量的结果。的 提出的研究的基本原理是，公开的网络多样性措施可能有助于 健康计划更好地了解自己的网络，帮助少数民族患者做出登记决定， 从而改善下游成果。使用一组独特的国家Medicare Advantage网络数据 与自我报告的提供者种族/民族相联系，我们提出了两个具体目标：1）制定一个衡量标准， 初级保健医生网络的多样性，以及2）确定是否可以获得不同的初级保健医生 网络与减少差异和改善少数民族患者的结果有关。本研究 创新之处在于它将采用一种新的供应商网络和种族/民族数据的联系来衡量 供应商网络的多样性，是第一个研究是什么导致异质性的差距 跨计划在完成这项工作后，我们希望我们的贡献是一个新开发的衡量标准， 提供商网络种族/民族，可以更好地告知利益相关者提供商网络的多样性， 更好地理解不同的提供者网络对少数群体入学者的结果所起的作用。 这一贡献将是巨大的，因为超过300万黑人和西班牙裔医疗保险受益人将获得他们的医疗保险。 医疗保险优势计划的护理，我们几乎不了解他们可以访问的提供者 以及这种机会是否是这一人群中不平等的驱动因素。这项研究的结果将有助于 为我们理解Medicare Advantage中的差异机制奠定了重要基础， 将为今后关于这一主题的研究奠定基础。

Project Summary Black and Hispanic Medicare beneficiaries enroll at higher rates in the Medicare Advantage program but receive lower quality of care and experience worse outcomes than their white counterparts. These disparities vary markedly across plans, with some managing to deliver high quality care for traditionally marginalized populations. It is not currently known what characteristics of these plans contribute to lower disparities for Black and Hispanic enrollees. Prior work has established that Black and Hispanic patients tend to have better outcomes across various conditions when seeing physicians and other providers of the same race/ethnicity. It is not known to what extent MA plans' networks include minority physicians, and if the physician diversity in plans' networks have downstream effects on enrollee health disparities. Without an understanding of whether enrollees have access to a diverse set of providers in the Medicare Advantage program, these disparities are likely to continue. Our long-term goal is to identify strategies to reduce health disparities for Black and Hispanic enrollees in the Medicare Advantage program. The objective of this application is to develop novel methods to measure the diversity of Medicare Advantage primary care provider networks, and to determine if network diversity is an important factor in addressing health disparities. Our central hypothesis is that more diverse primary care provider networks will deliver higher quality outcomes for Black and Hispanic enrollees. The rationale that underlies the proposed research is that publicly available measures of network diversity may help health plans better understand their own networks and help minority patients make enrollment decisions that lead to improved downstream outcomes. Using a unique set of national Medicare Advantage network data linked with self-reported provider race/ethnicity, we propose two specific aims: 1) to develop a measure of primary care physician network diversity, and 2) to determine if access to diverse primary care physician networks is associated with a reduction in disparities and improved outcomes for minority patients. This study is innovative in that it will employ a novel linkage of provider network and race/ethnicity data to measure the diversity of provider networks and is one of the first studies on what contributes to heterogeneity in disparities across plans. Upon completion of this work, we expect our contribution to be a newly developed metric of provider network race/ethnicity that can better inform stakeholders on the diversity of provider networks and a better understanding of the role that diverse provider networks play on the outcomes of minority enrollees. This contribution will be significant as over 3 million Black and Hispanic Medicare beneficiaries receive their care from Medicare Advantage plans and we have little to no understanding of the providers they have access to and whether this access is a driver of disparities in this population. The findings from this study will help to lay an important groundwork in our understanding of the mechanisms of disparities in Medicare Advantage and will build towards future studies on this topic.