WASHINGTONAs one of the biggest and most influential payers in medicine, Medicare should use its clout to help reduce and eliminate the disparities in care for racial and ethnic minorities, according to a report from an independent panel of the National Academy of Social Insurance.
The report, along with an updated survey on health plans' progress in identifying disparities, was released at a press briefing sponsored by the journal Health Affairs. NASI, a Washington-based nonprofit organization of experts in Social Security, Medicare, and social insurance, made 17 recommendations on how Medicare can improve quality of, and access to, care for minorities, educate health care providers in cultural competence, and hold them accountable for reducing disparities.
About 9 million of Medicare's 42 million beneficiaries are minorities. Those minority beneficiaries generally are in poorer health, according to NASI. For example, more black Medicare beneficiaries than white beneficiaries have diabetes, 30% and 18%, respectively.
Medicare is uniquely positioned to influence practice patterns, and has a duty to ensure that its recipients get care on a fair and equitable basis, said Bruce C. Vladeck, Ph.D., chairman of the NASI panel and Interim President of the University of Medicine and Dentistry of New Jersey, Newark.
NASI's report was funded by the Robert Wood Johnson Foundation, the California Endowment, and the Joint Center for Political and Economic Studies.
The panel recommended that the federal government start addressing gaps in care by creating incentives to improve quality.
To increase access, Medicare should ensure that minorities are enrolled in Medicare supplemental insuranceor Medigapplans, said the report. Health systems should increase the number of minority providers and staff, and enhance cultural competence training. Providers should collect data that will help identify minorities and assess their special needs, according to the panel.
Health plans already collect such data, according to Karen Ignani, president and CEO of America's Health Insurance Plans. AHIP, with funding from the Robert Wood Johnson Foundation, queried 260 plans on how and why they collect data on minority enrollees. According to the responsesfrom 156 plans, covering 87 million peoplethere has been a 500% increase in data collection since a previous query in 2001, said Ms. Ignani.
Overall, 58.2 million of the 87 million enrollees are in plans that collect race and ethnicity data. Medicare and Medicaid plans were most likely to collect that data. Race and ethnicity data were collected on 94% of enrollees in Medicare and Medicaide plans, compared with 63% of enrollees in commercial plans.
The top three reasons for collecting the data were to support language and culturally appropriate communications to enrollees, to identify racial and ethnic disparities in health care, and to implement or strengthen quality improvement efforts, according to the AHIP report. Commercial plans also say they use the data to conduct research and to identify patients with risk factors for some diseases.
Although more plans are collecting data, "we think we have much more to do," Ms. Ignani said.
But barriers to data collection exist. Six states have laws or rules that prevent insurers from collecting race and ethnicity data, although only as part of an application process. However, those laws have led to the mistaken perception that any data collection is illegal, said Ms. Ignani.
Title VI of the federal 1964 Civil Rights Act prohibits discrimination on racial or ethnic grounds, which has led to some concern that data collection might be seen as illegal.
But a June 2006 analysis by the George Washington University School of Public Health and Health Services found that not only is it legal for insurers to collect and report health quality data by race and ethnicity, but that it might be seen as proof of complying with Title VI when it is used to improve quality of care. The researchers asked the Department of Health and Human Services' Office of Civil Rights to issue guidance in this area, but have not gotten a response yet, according to Sara Rosenbaum, chairman of the university's health policy department.