Income-related disparities in Medicare advantage behavioral health care quality.
Health Serv Res
; 58(3): 579-588, 2023 06.
Article
em En
| MEDLINE
| ID: mdl-36579742
ABSTRACT
OBJECTIVE:
To inform efforts to improve equity in the quality of behavioral health care by examining income-related differences in performance on HEDIS behavioral health measures in Medicare Advantage (MA) plans. DATA SOURCES AND STUDYSETTING:
Reporting Year 2019 MA HEDIS data were obtained and analyzed. STUDYDESIGN:
Logistic regression models were used to estimate differences in performance related to enrollee income, adjusting for sex, age, and race-and-ethnicity. Low-income enrollees were identified by Dual Eligibility for Medicare and Medicaid or receipt of the Low-Income Subsidy (DE/LIS). Models without and with random effects for plans were used to estimate overall and within-plan differences in measure performance. Heterogeneity by race-and-ethnicity in the associations of low-income with behavioral health quality were examined using models with interaction terms. DATA COLLECTION/EXTRACTIONMETHODS:
Data were included for all MA contracts in the 50 states and the District of Columbia that collect HEDIS data. PRINCIPALFINDINGS:
For six of the eight measures, enrollees with DE/LIS coverage were more likely to have behavioral health conditions that qualify for HEDIS measures than higher income enrollees. In mixed-effects logistic regression models, DE/LIS coverage was associated with statistically significantly worse overall performance on five measures, with four large (>5 percentage point) differences (-7.5 to -11.1 percentage points) related to follow-up after hospitalization and avoidance of drug-disease interactions. Where the differences were large, they were primarily within-plan rather than between-plan. Interactions between DE/LIS and race-and-ethnicity were statistically significant (p < 0.05) for all measures; income-based quality gaps were larger for White enrollees than for Black or Hispanic enrollees.CONCLUSIONS:
Low income is associated with lower performance on behavioral health HEDIS measures in MA, but these associations differ across racial-and-ethnic groups. Improving care integration and addressing barriers to care for low-income enrollees may improve equity across income levels in behavioral health care.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Qualidade da Assistência à Saúde
/
Medicare Part C
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article