Finding Solutions for Disparities Associated with Star Ratings

由医疗保险和医疗补助服务中心（CMS）建立，医疗保险部件的星星评级系统 C&D（星星评级，以下简称）是一个健康计划质量报告系统，具有相关的奖金支付， 自2012年以来，健康计划的注册激励措施。研究人员已经报道了星星的差异性影响 评级：例如，少数种族/民族更有可能被排除在糖尿病测量计算之外 坚持比非西班牙裔白人，因此少数民族可能更有可能被排除在质量 这一措施的改进举措可能会加剧健康方面的差距。一个关键的障碍， 解决这种差异是一个全面的政策建议，涉及到星星评级的影响， 没有种族/族裔差异数据。本项目的目标是确保星星评级包括一套 解决测量计算中的差异的测量，并评估星星评级奖金的影响 减少药物使用中的种族/民族差异。我们的策略是（1）增加星星 对从药房质量联盟测量概念库存中选择的药物利用测量进行评级 （PMCI）和其他常用药物利用（PIU）指标（星星Plus，下文），以及（2） 比较奖金实施前后药物利用的种族/民族差异 奖金发放、“双增”县与常规县之间的差异。一个专注于 只有星星评级中的药物利用指标是有保证的，因为这些指标占高 在星星评级分数中的百分比（2013年D部分为45%），其与其他指标的相关性仅为 适度。奖金支付与改进的计划福利结构有关，这可能会减少 药物利用的种族/民族差异。在上一个赠款期间，我们发现，选择适当的 药物利用措施可以解决与Medicare Part D政策相关的种族/民族差异。 我们这个延续项目的目标是对医疗保险A/B/D部分数据（2010-2015年）进行分析， 链接到地区卫生资源文件、橙子书数据文件和关于双倍/定期奖金的CMS数据 个县我们还将进行疾病特异性分析。目的1：检验使用药物的假设 当前星星评级中的使用措施对少数种族/民族的健康产生了负面影响。目标2：测试 假设使用星星Plus可以减少与星星相关的种族/民族差异 评级.目标3：检验星星评级公司的奖金支付与 药物利用的种族/民族差异。我们的预期成果是提供政策建议 解决不同老年人之间星星评级的重要差异问题。影响：该项目将有助于 使减少差距的目标与迅速增加的按业绩计薪和公开报告倡议相一致。 这个项目是响应国家老龄化研究所的使命驱动的战略目标，“了解 健康差距，并制定战略，以改善不同人口中老年人的健康状况。

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.”