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

项目摘要 黑人和西班牙裔联邦医疗保险受益人参加联邦医疗保险优势计划的比率较高，但 与白人同龄人相比，他们得到的护理质量较低，结果也更差。这些差距 不同计划的差异很大，一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缩小 黑人和西班牙裔参赛者。先前的研究已经确定，黑人和西班牙裔患者往往有更好的 在同一种族/民族的医生和其他提供者就诊时，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族裔医生，以及 计划的网络对参保者的健康差距具有下游影响。却不知道是否 参保人可以在Medicare Advantage计划中获得不同的提供者，这些差异是 很可能还会继续下去。我们的长期目标是确定减少黑人和西班牙裔健康差距的策略 参加联邦医疗保险优势计划的人。该应用程序的目标是开发新的方法来 衡量Medicare Advantage初级保健提供者网络的多样性，并确定网络是否 多样性是解决健康差距的一个重要因素。我们的中心假设是更多样化的 初级保健提供者网络将为黑人和西班牙裔登记者提供更高质量的结果。这个 这项拟议的研究的基本原理是，公开的网络多样性衡量标准可能会有所帮助 健康计划更好地了解自己的网络，并帮助少数族裔患者做出登记决定 导致下游结果的改善。使用一组唯一的全国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)制定一项衡量 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族裔患者的预后有关。本研究 创新之处在于，它将采用提供商网络和种族/民族数据的新联系来衡量 提供商网络的多样性，是关于造成差异异质性的首批研究之一 不同的计划。在完成这项工作后，我们预计我们的贡献将是一个新开发的指标 提供商网络种族/民族，可以更好地向利益相关者提供有关提供商网络的多样性和 更好地了解不同的提供者网络对少数族裔参与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收到他们的 从Medicare Advantage计划获得护理，我们对他们可以访问的提供者知之甚少或一无所知 以及这种准入是否是造成这一人群不平等的一个因素。这项研究的发现将有助于 为我们理解医疗保险优势和差距的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.