Quality of Care Disparities Among American Indian, Alaska Native Medicare Advantage Enrollees

There is significant room for improvement in the treatment of diagnosed conditions for American Indian/Alaska Native (AI/AN) beneficiaries, according to study authors who compared the differences in care quality across multiple populations.

Plan differences were reported as the result of the majority of overall differences in quality of care for AI/AN compared to White beneficiaries.

Researchers extracted info from the 2019 Health care Effectiveness Data and Information Set (HEDIS) to determine the differences in care and utilized the Medicare Consumer Assessment of Health care Providers and Systems (CAHPS) survey data from 2019.

According to researchers, responses were received from 318,043 Medicare beneficiaries of the 874,080 the 2019 Medicare CAHPS survey attempted to contact—a 36.4% response rate.

Results showed for 8 of 26 measures AI/AN beneficiaries were more likely than White beneficiaries to receive care that met clinical standards and less likely for 5 of 26 measures (P < 0.05 and greater than 1-percentage-point difference).

The 13 remaining measures resulted in similar care being received by AI/AN and White beneficiaries.

“These findings indicate the need for improved clinical care for all beneficiaries,” wrote researchers. “For AI/AN beneficiaries, there is a particular need for improvement in the treatment of diagnosed conditions, including diabetes, chronic obstructive pulmonary disease, and alcohol and other forms of substance abuse.”

While findings showed mixed results in quality of care, researchers observed higher rates of breast cancer screening and better management of rheumatoid arthritis for AI/AN beneficiaries compared to White beneficiaries.

“Additional research is needed to determine the specific mechanisms underlying these within-plan differences,” concluded study authors. “Identifying and intervening on these mechanisms, which may involve working with tribal elders to restore trust, improving recruitment and retention of providers at IHS facilities, having MA plans institute programs to improve the cultural sensitivity of providers and staff, and providing transportation and language services and other supplemental benefits to AI/AN beneficiaries who need them, should help address the significant health and health care inequities affecting AI/AN people.”

Reference:
Martino SC, Elliot MN, Klein DJ, et al. Disparities in the quality of clinical care delivered to American Indian/Alaska Native Medicare Advantage enrollees. Health Aff. 2022;41(5). doi:10.1377/hlthaff.2021.0183