Solving racial/ethnic disparities associated with Medicare Part D Star Ratings

Abstract

Objective

Medicare Part D Star Ratings are instrumental in shaping healthcare quality improvement efforts. However, the calculation metrics for medication performance measures for this program have been associated with racial/ethnic disparities. In this study, we aimed to explore whether an alternative program, named Star Plus by us that included all medication performance measures developed by Pharmacy Quality Alliance and applicable to our study population, would reduce such disparities among Medicare beneficiaries with diabetes, hypertension, and/or hyperlipidemia.

Method

We conducted an analysis of a 10% random sample of Medicare A/B/D claims linked to the Area Health Resources File. Multivariate logistic regressions with minority dummy variables were used to examine racial/ethnic disparities in measure calculations of Star Ratings and Star Plus, respectively.

Results

Adjusted results indicated that relative to non-Hispanic Whites (Whites), racial/ethnic minorities had significantly lower odds of being included in the Star Ratings measure calculations: the odds ratios (ORs) for Blacks, Hispanics, Asians, and Others were 0.68 (95% confidence interval [CI] = 0.66–0.71), 0.73 (CI = 0.69–0.78), 0.88 (CI = 0.82–0.93), and 0.92 (CI = 0.88–0.97), respectively. In contrast, every beneficiary in the sample was included in Star Plus. Further, racial/ethnic minorities had significantly higher increase in the odds of being included in measure calculation in Star Plus than Star Ratings. The ORs for Blacks, Hispanics, Asians, and Others were 1.47 (CI = 1.41–1.52), 1.37 (CI = 1.29–1.45), 1.14 (CI = 1.07–1.22), and 1.09 (CI = 1.03–1.14), respectively.

Conclusions

Our study demonstrated that racial/ethnic disparities may be eliminated by including additional medication performance measures to Star Ratings.

Keywords:

• Disparities
• medication utilization
• performance measures
• Medicare
• ratings

Transparency

Declaration of 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.

Declaration of financial and other relationships

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG049696. Xiaobei Dong, Chi Chun Steve Tsang, Jamie A. Browning, Jim Y. Wan, Samuel Dagogo-Jack, and Yongbo Sim: None. Marie A. Chisholm-Burns: Received funding from Carlos and Marguerite Mason Trust. William C. Cushman: Received grant funding from Eli Lilly. Junling Wang: Received funding from AbbVie, Curo, Bristol Myers Squibb, Pfizer, and Pharmaceutical Research and Manufacturers of America (PhRMA) and serves on Value Assessment & Health Outcomes Research Advisory Committee of the PhRMA Foundation.

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

Author contributions

Xiaobei Dong, Chi Chun Steve Tsang, Jamie A. Browning, and Yongbo Sim: concept and design, analysis and interpretation of data, and writing (original draft and editing). Jim Y. Wan, Marie A. Chisholm-Burns, Samuel Dagogo-Jack, and William C. Cushman: funding acquisition, concept and design, analysis and interpretation of data, and writing (original draft and editing). Junling Wang: funding acquisition, concept and design, analysis and interpretation of data, writing (original draft and editing), and project administration. All authors read and approved the final manuscript.

Acknowledgements

The authors would like to acknowledge assistance with the formatting of the final manuscript from Lorraine Todor and Hannah Foster, doctor of pharmacy students 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 email at [email protected], or by phone at 888-973-7322.