Addressing racial/ethnic disparities associated with Medicare Part D Star Ratings among population with Alzheimer’s disease and related dementias

ABSTRACT

Background

Previous studies noted that racial/ethnic minority groups were less likely than non-Hispanic White beneficiaries to be included in the assessment of medication utilization measures of Medicare Part D Star Ratings due to restrictive inclusion criteria for measure calculation. This study explored whether adding a measure with less stringent inclusion criteria to Star Ratings can reduce disparities in measure assessment among beneficiaries with Alzheimer’s disease and related dementias (ADRD).

Methods

This cross-sectional study utilized 2017 Medicare databases linked to Area Health Resources Files. Multivariable logistic regression was used to compare disparities before and after adding the new measure.

Results

By adding the new measure, disparities in the odds for assessment inclusion between non-Hispanic White beneficiaries and Black, Hispanic, Asian, and Other beneficiaries were respectively reduced by 97% (odds ratio, or OR = 1.97, 95% Confidence Interval or CI = 1.89–2.05), 72% (OR = 1.72, 95% CI = 1.58–1.87), 115% (OR = 2.15, 95% CI = 1.87–2.46), and 44% (OR = 1.44, 95% CI = 1.28–1.62).

Conclusions

To improve the selection of medication utilization measures in Star Ratings among beneficiaries with ADRD, policymakers should investigate the optimal composition of measures to better align the interests of patients, providers, and health plans.

KEYWORDS:

• Alzheimer’s disease and related dementias
• healthcare outcome
• Medicare
• medication utilization
• program evaluation
• racial/ethnic disparities

Declaration of interest

J Wang received funding from AbbVie, Curo, Bristol Myers Squibb, Pfizer, and Pharmaceutical Research and Manufacturers of America (PhRMA) and serves on the Value Assessment-Health Outcomes Research Advisory Committee of the PhRMA Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge assistance with checking the number accuracy of the manuscripts from Xiangjun Zhang, a Postdoctoral Scholar at the University of Tennessee Health Science Center College of Pharmacy.

Data availability statement

Medicare databases are United States federal databases sponsored by the Centers for Medicare & Medicaid Services (CMS). These data are available to researchers through the Research Data Assistance Center (ResDAC) at the University of Minnesota, according to a strict protocol for data requests. Users of Medicare databases cannot disclose to, nor share the data with, individuals not listed in the Data Use Agreement. ResDAC can be reached via e-mail at [email protected], or by phone at 888-973-7322.

Ethical approval

This study was deemed exempt by the Institutional Review Board of the corresponding author’s institution (approval number #21-08349-NHSR).

Additional information

Funding

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG049696. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.