Association of Race and Ethnicity and Medicare Program Type With Ambulatory Care Access and Quality Measures

Key PointsQuestionDo individuals from racial and ethnic minority groups receive lower rates of ambulatory care access and quality than individuals of other races and ethnicities in Medicare Advantage and/or traditional Medicare, and how do the 2 programs compare on these measures for minority beneficiaries? FindingsIn this exploratory study of a nationally representative sample of 26887 Medicare beneficiaries in 2015-2018, enrollment in Medicare Advantage compared with traditional Medicare was significantly associated with better outcomes on 1 of 3 access measures and 3 of 3 quality measures for minority beneficiaries; however, minority beneficiaries were also significantly more likely to experience worse outcomes for most access and quality metrics compared with other beneficiaries within both programs. MeaningMedicare Advantage, compared with traditional Medicare, was significantly associated with better outcomes for ambulatory care access and quality among minority beneficiaries, but minority beneficiaries nonetheless experienced worse outcomes for most of these measures compared with other beneficiaries within both Medicare programs. ImportanceThere are racial inequities in health care access and quality in the United States. It is unknown whether such differences for racial and ethnic minority beneficiaries differ between Medicare Advantage and traditional Medicare or whether access and quality are better for minority beneficiaries in 1 of the 2 programs. ObjectiveTo compare differences in rates of enrollment, ambulatory care access, and ambulatory care quality by race and ethnicity in Medicare Advantage vs traditional Medicare. Design, Setting, and ParticipantsExploratory observational cohort study of a nationally representative sample of 45833 person-years (26887 persons) in the Medicare Current Beneficiary Survey from 2015 to 2018, comparing differences in program enrollment and measures of access and quality by race and ethnicity. ExposuresMinority race and ethnicity (Black, Hispanic, Native American, or Asian/Pacific Islander) vs White or multiracial; Medicare Advantage vs traditional Medicare enrollment. Main Outcomes and MeasuresSix patient-reported measures of ambulatory care access (whether a beneficiary had a usual source of care in the past year, had a primary care clinician usual source of care, or had a specialist visit) and quality (influenza vaccination, pneumonia vaccination, and colon cancer screening). ResultsThe final sample included 6023 persons (mean age, 68.9 [SD, 12.6] years; 57.3% women) from minority groups and 20864 persons (mean age, 71.9 [SD, 10.8] years; 54.9% women) from White or multiracial groups, who accounted for 9816 and 36017 person-years, respectively. Comparing Medicare Advantage vs traditional Medicare among minority beneficiaries, those in Medicare Advantage had significantly better rates of access to a primary care clinician usual source of care (79.1% vs 72.5%; adjusted marginal difference, 4.0%; 95% CI, 1.0%-6.9%), influenza vaccinations (67.3% vs 63.0%; adjusted marginal difference, 5.2%; 95% CI, 1.9%-8.5%), pneumonia vaccinations (70.7% vs 64.6%; adjusted marginal difference, 6.1%; 95% CI, 2.7%-9.4%), and colon cancer screenings (69.4% vs 61.1%; adjusted marginal difference, 7.1%; 95% CI, 3.8%-10.3%). Comparing minority vs White or multiracial beneficiaries across both programs, minority beneficiaries had significantly lower rates of access to a primary care clinician usual source of care (adjusted marginal difference, 4.7%; 95% CI, 2.5%-6.8%), specialist visits (adjusted marginal difference, 10.8%; 95% CI, 8.3%-13.3%), influenza vaccinations (adjusted marginal difference, 4.3%; 95% CI, 1.2%-7.4%), and pneumonia vaccinations (adjusted marginal difference, 6.4%; 95% CI, 3.9%-9.0%). The interaction of race and ethnicity with insurance type was not statistically significant for any of the 6 outcome measures. Conclusions and RelevanceIn this exploratory study of Medicare beneficiaries in 2015-2018, enrollment in Medicare Advantage vs traditional Medicare was significantly associated with better outcomes for access and quality among minority beneficiaries; however, minority beneficiaries were significantly more likely to experience worse outcomes for most access and quality measures than White or multiracial beneficiaries in both programs. This observational study uses data from the Medicare Current Beneficiary Survey from 2015 to 2018 to compare differences in rates of enrollment, ambulatory care access, and ambulatory care quality for minority beneficiaries vs White or multiracial beneficiaries in Medicare Advantage vs traditional Medicare plans.

Automated summary

This study compared rates of enrollment, ambulatory care access, and ambulatory care quality for minority beneficiaries in Medicare Advantage vs traditional Medicare plans. It found that minority beneficiaries generally had worse outcomes compared to White or multiracial beneficiaries, but Medicare Advantage was associated with better outcomes for some measures.