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MIPPA Section 185. Health Disparities Summit, May 22, 2009. Legislative Requirements. Evaluate data collection approaches with respect to disparities in health care on the basis of race, ethnicity, and gender [Section (a)]

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mippa section 185

MIPPA Section 185

Health Disparities Summit, May 22, 2009

legislative requirements
Legislative Requirements
  • Evaluate data collection approaches with respect to disparities in health care on the basis of race, ethnicity, and gender [Section (a)]
  • Prepare a report to Congress that identifies approach to measuring and reporting on health disparities [Sections (b)(1)(A) and (b)(1)(B)]
  • Implement approach identified [Section (c)]
  • Evaluate disparities measurement and reporting effort and prepare reports to Congress, with recommendations for improvement [Section (b)(2)]
examples of potential benefits section 185 measurement and reporting
Examples of Potential Benefits Section 185 Measurement and Reporting
  • Benchmarking, awareness, and accountability
  • Quality improvement
  • Supporting consumer choice
  • Program monitoring and oversight
issues we need to address for report to congress
Issues We Need to Address for Report to Congress
  • Data on race and ethnicity
  • Measuring disparities
  • Public reporting
  • Evaluation
cms race ethnicity data sources
CMS Race/Ethnicity Data Sources
  • Enrollment Data Base (EDB)
    • Enrollment, eligibility, and characteristics data for entire Medicare population
  • Special data collection initiatives
    • Data collections for specific topics and subpopulations
    • E.g., Consumer Assessment of Healthcare Providers and Systems (CAHPS)
race ethnicity data in the edb
Race/Ethnicity Data in the EDB
  • Comes to CMS from the Social Security Administration
    • SSA captured race/ethnicity data when a person applied for a Social Security number (i.e., completed form SS-5)
    • SS-5 data (including person’s race/ethnicity) are stored at SSA in their Numident file
    • Data on race/ethnicity is transferred from SSA to CMS after person become eligible for Medicare
      • I.e., Data are transferred from Numident to EDB
race ethnicity data in the edb cont
Race/Ethnicity Data in the EDB, cont.
  • Some history:
    • From 1936 (when Social Security began) until 1980, the SS-5 was virtually unchanged.
      • The available race categories on the SS-5 were White, Black, Other. If the race field was left blank, the person was coded as unknown.
      • A large majority of current Medicare beneficiaries would have applied for a Social Security number between 1936-1980.
    • In 1980, the SS-5 was revised to expand the coding of race/ethnicity
      • New categories were: White; Black; Hispanic; Asian, Asian American, Pacific Islander; American Indian or Alaska native.
      • People who applied for a Social Security number between 1936-1980 would only submit a new SS-5 when seeking a replacement Social Security card or changing personal information (e.g., name change by marriage).
initiatives to improve race ethnicity coding in the edb
Initiatives to Improve Race/Ethnicity coding in the EDB
  • Short-term improvement
    • Probabilistic approach using surname
  • Intermediate-term improvement
    • Enhancements to probabilistic approach
    • SSA efforts to improve capture of race/ethnicity data
  • Long-term improvement
    • Capture race/ethnicity through on-going CMS primary data collection process (i.e., electronic health records)
probabilistic approach using surname
Probabilistic Approach Using Surname
  • Using census data, the Census Bureau has identified the probability that people with a given surname will identify themselves with a given race/ethnic category
  • We have beneficiary name in our administrative data
  • Using the data from the Census Bureau, we associated the probability of being Hispanic with every Medicare beneficiary based on their surname.
  • We coded beneficiaries as being Hispanic if the probability associated with their surname was above a high threshold
  • We did the same thing for Asian American surnames
  • [Also used administrative data from other sources (e.g., if person requested Medicare & You Handbook in Spanish s/he was coded Hispanic)]
in short
In short…
  • The current race/ethnicity data we have on the full Medicare population contains significant gaps
  • We have taken analytic steps to improve the data and will continue with these efforts
  • In some cases, more reliable data on race/ethnicity is captured separately for specific topics and subpopulations. We will use these data when available and appropriate
  • This will create something of a patchwork of race/ethnicity data that will be used in addressing Section 185 requirements
phase 1
Phase 1
  • Health Plan Measurement with Fee-for-Service comparisons
    • CAHPS and HEDIS Analyses by Race/Ethnicity and Gender
  • Part D measures
    • Medicare Advantage Prescription Drug Plans
    • Stand-alone Prescription Drug Plans
phase 1 cahps
Phase 1: CAHPS
  • The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is conducted annually by CMS to assess the experiences of beneficiaries in Medicare Advantage and Medicare Prescription Drug Plans.
  • The health plan measures are available for Medicare Advantage plans and fee-for-service.
  • The prescription drug plan measures are available for Medicare Advantage Prescription Drug Plans (MA-PDs) and stand-alone Prescriptions Drug Plans (PDPs).
cahps health care measures
CAHPS Health Care Measures
  • Getting Needed Care (composite)
  • Getting Care Quickly (composite)
  • Doctors who Communicate Well (composite)
  • Health Plan Customer Service (composite)
  • Overall Rating of Health Plan
  • Overall Rating of Care Received
  • Influenza Vaccination
  • Pneumonia Shot
cahps prescription drug measures
CAHPS Prescription Drug Measures
  • Ease of Getting Needed Prescription Drugs (composite)
  • Getting Information from the Plan about Prescription Drug Coverage and Cost (composite)
  • Overall Rating
  • Willingness to Recommend Drug Plan
phase 1 hedis
Phase 1: HEDIS
  • The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of health plan performance measures that were developed by the National Committee for Quality Assurance (NCQA).
  • CMS requires the annual submission of HEDIS data from Medicare Advantage contracts.
  • A subset of HEDIS measures are available for the fee-for-service population by geographic area.
    • Based on administrative data
hedis measures
HEDIS Measures
  • Breast cancer screening
  • LDL testing for diabetics
  • Retinal eye exams for diabetics
  • HbA1c testing for diabetics
  • LDL testing for cardiovascular conditions
  • Persistence of beta blockers
  • Medical attention for nephropathy
  • Annual monitoring of patients on persistent medications
  • Antidepressant medication management
  • Beta blocker treatment after a heart attack
  • Disease modifying anti-rheumatic drug therapy in rheumatoid arthritis
  • Colorectal cancer screening

This is a subset of HEDIS measures where FFS comparisons are feasible.

identifying race ethnicity for cahps hedis
Identifying Race/Ethnicity for CAHPS/HEDIS
    • Self-reported information about race/ethnicity
      • Are you of Spanish, Hispanic or Latino origin or descent?
        • No, not Spanish/Hispanic/Latino
        • Yes, Spanish/Hispanic/Latino
      • What is your race? Please choose one or more.
        • White
        • Black or African American
        • Asian
        • Native Hawaiian or other Pacific Islander
        • American Indian or Alaska Native
    • Use imputed race/ethnicity values
next steps for phase 1
Next Steps for Phase 1
  • Develop methodology for producing plan-level/geographic estimates by race/ethnicity and gender
    • Sample size issues
    • Combining multiple years of data
    • Level of detail for race/ethnicity
  • Make recommendations for measure selection
  • Produce estimates
phase 2
Phase 2
  • Expand to additional provider settings
    • Home Health Agencies
    • Nursing Homes
    • Hospitals
    • ESRD Facilities
medicare options compare
Medicare Options Compare
  • Currently, CMS presents HEDIS, CAHPS and other performance information by contract on Medicare Options Compare.
  • The information is presented at three levels
    • Summary measure of quality and performance
    • Topic/domain level scores
    • Individual measure scores
current directions for medicare options compare
Current Directions for Medicare Options Compare
  • Currently, conducting consumer testing to determine the best way to add Fee-for-Service comparisons to the website, where available, for Fall 2009.
  • Once the measures are selected for MIPPA Section 185, we plan to conduct testing to determine the best way to present this information to the public.
consumer testing approaches
Consumer Testing: Approaches
  • Respondents
    • Medicare beneficiaries, family caregivers
    • Clinicians who serve as Information Intermediaries
    • Individuals who are interested in the use of the data for Quality Improvement
  • Methods
    • One-on-one in-depth interviews for cognitive testing
    • Small group discussions
examples of potential analyses
Examples of Potential Analyses
  • Examine changes in disparities measures
    • Cross-sectional time series analysis
    • Include measures that are reported and some that are not
  • Monitor usage of web pages
  • Obtain feedback from sample of users who came to the website
  • Obtain feedback from sample of entities being measured
    • What are they doing to improve
  • Obtain feedback from other stakeholders
discussion ideas from the group
Discussion/Ideas from the Group
  • Data on Race and Ethnicity
  • Measuring Disparities
  • Public Reporting
  • Evaluation
  • Other considerations
  • Elizabeth Goldstein, Ph.D.
  • Center for Drug and Health Plan Choice
  • 410-786-6665
  • Thomas Reilly, Ph.D.
  • Office of Research, Development, and Information
  • 410-786-0631