Racial/Ethnic Disparities in Medicare Beneficiaries' Care Coordination Experiences.

O RIGINAL A RTICLE Racial/Ethnic Disparities in Medicare Beneficiaries’ Care Coordination Experiences Steven C. Martino, PhD,* Marc N. Elliott, PhD, w Katrin Hambarsoomian, MS, w Robert Weech-Maldonado, PhD, z Sarah Gaillot, PhD, y Samuel C. Haffer, PhD, y and Ron D. Hays, PhD 8 Background: Little is known about racial/ethnic differences in the experience of care coordination. To the extent that they exist, such differences may exacerbate health disparities given the higher prevalence of some chronic conditions among minorities. Objective: To investigate the extent to which racial/ethnic dis- parities exist in the receipt of coordinated care by Medicare bene- ficiaries. Subjects: A total of 260,974 beneficiaries who responded to the 2013 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Methods: We fit a series of linear, case-mix adjusted models pre- dicting Medicare CAHPS measures of care coordination from race/ ethnicity. Results: Hispanic, black, and Asian/Pacific Islander (API) benefi- ciaries reported that their personal doctor had medical records and other relevant information about their care significantly less often than did non-Hispanic white beneficiaries (2 points for Hispanics, 1 point for blacks, and 4 points for APIs on a 100-point scale). These 3 groups also reported significantly greater difficulty getting timely follow-up on test results than non-Hispanic white benefi- ciaries ( 9 points for Hispanics, 1 point for blacks, 5 points for APIs). Hispanic and black beneficiaries reported that help was provided in managing their care significantly less often than did non-Hispanic white beneficiaries (2 points for Hispanics, 3 points for blacks). API beneficiaries reported that their personal doctor discussed their medications and had up-to-date information From the *RAND Corporation, Pittsburgh, PA; wRAND Corporation, Santa Monica, CA; zDepartment of Health Services Administration, University of Alabama, Birmingham, AL; yCenters for Medicare & Medicaid Services, Baltimore, MD; and 8UCLA Division of GIM/HSR, Los An- geles, CA. Supported by a contract from the Centers for Medicare & Medicaid Services (HHSM-500-2005-00028I). The authors declare no conflict of interest. The views expressed in this article are those of the authors and do not necessarily reflect the views of the US Department of health and Human Services or the Centers for Medicare & Medicaid Services. Reprints: Steven C. Martino, PhD, RAND Corporation, 4570 Fifth Ave., Suite 600, Pittsburgh, PA 15213-2665. E-mail: martino@rand.org. Supplemental Digital Content is available for this article. Direct URL cita- tions appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website, www.lww-medical care.com. Copyright r 2016 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0025-7079/16/000-000 Medical Care Volume 00, Number 00, ’’ 2016 on care from specialists significantly less often than did non-His- panic white beneficiaries (2 and 4 points, respectively). Discussion: These results suggest a need for efforts to address ra- cial/ethnic disparities in care coordination to help ensure high- quality care for all patients. Public reporting of plan-level perfor- mance data by race/ethnicity may also be helpful to Medicare beneficiaries and their advocates. Key Words: CAHPS, care coordination, health disparities, Medi- care, race/ethnicity (Med Care 2016;00: 000–000) C are coordination has been defined as “the deliberate integration of patient care activities between 2 or more participants involved in a patient’s care to facilitate appro- priate delivery of health care services.” 1 Gaps in care coor- dination are common and often lead to delayed access to care, a lower likelihood of receiving preventive services, increased hospital admissions and emergency department visits, patient and provider dissatisfaction, and greater health care spending. 1–6 Care coordination is especially important for Medicare beneficiaries, the majority of whom have Z1 chronic con- ditions that require care from multiple providers in a variety of settings. Annually, Medicare beneficiaries see a median of 2 primary care providers and 5 specialists in 4 different practi- ces. 7 Gaps in coordination among these providers and settings may lead to poor health outcomes and increased hospital- izations and associated health care expenditures. 8–10 The need to improve care coordination in the Medicare population is reflected in the recent decision by the Centers for Medicare & Medicaid Services (CMS) to reimburse primary care providers for between-visit services required to coordinate care for pa- tients with Z2 chronic conditions. 11 Likewise, the Affordable Care Act includes several provisions to accelerate efforts to coordinate care for individuals with multiple chronic con- ditions through practice models such as accountable care or- ganizations and patient-centered medical homes. 12 Whereas racial/ethnic disparities in both clinical process measures and some aspects of patient experiences of care (eg, access to care and patient-provider communication) are well documented, 13–18 little is known about the degree to which such disparities exist in patient-reported care coordination. www.lww-medicalcare.com | Copyright r 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.