Finding Solutions for Disparities Associated with Star Ratings

由联邦医疗保险和医疗补助服务中心(CMS)建立的联邦医疗保险部件星级评级系统 C&D(下称星级)是一种健康计划质量报告系统，与奖金支付和 自2012年以来，医疗计划的参保激励措施。研究人员已经报道了恒星的差异含义 评级：例如，种族/少数民族更有可能被排除在糖尿病测量计算之外 与非西班牙裔白人相比，少数族裔更有可能被排除在质量之外 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 解决这种差距是与星级评级对 不存在种族/民族差异。该项目的目标是确保星级评级包括一套 解决测量计算中差异的措施，并评估星级奖金的效果 在减少药物使用方面的种族/族裔差异方面的支出。我们的策略是：(1)加星 对从药房质量联盟措施概念清单中选择的药物利用措施进行评级 (PMCI)和其他常用药物利用(CUMU)措施(下称Star Plus)，以及(2) 比较实施奖金前后的种族/民族用药差异 支付，以及实行“双倍奖金”和定期发放奖金的县之间的差别。一个专注于 只有星级评级中的药物利用措施是有保证的，因为这些措施占了很高的 星级评分的百分比(2013年D部分为45%)及其与其他指标的相关性仅为 适中。奖金支付与改进的计划福利结构有关，这可能会减少 药物使用方面的种族/民族差异。在之前的授权期内，我们发现选择合适的 药物利用措施可能会解决与Medicare Part D政策相关的种族/民族差异。 我们继续项目的目标是对联邦医疗保险A/B/D部分数据(2010-2015)进行分析， 链接到Area Health Resources文件、Orange Book数据文件和CMS双倍/定期奖金数据 各县。我们还将进行针对疾病的分析。目标1：检验使用药物的假设 当前星级评级中的利用措施对少数族裔的健康产生了负面影响。目标2：测试 假设使用Star Plus可以减少与Star相关的种族/民族差异 收视率。目标3：测试星级奖金支付与减少 药物使用方面的种族/民族差异。我们的预期结果是提供政策建议 解决不同老年人之间星级评估中的重要差异问题。影响：此项目将有所帮助 使缩小差距的目标与迅速增长的绩效工资和公共报告倡议保持一致。 该项目是对国家老龄研究所使命驱动的战略目标的响应，目的是“了解 并制定战略，以改善不同人群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.”