Academy Health: 2016 Disparities Interest Group CMS Office of Minority Health Madeleine Shea, Deputy Director June 25, 2016
CMS OMH Mission and Vision Mission To ensure that the voices and the needs of the populations we represent (racial and ethnic minorities, sexual and gender minorities, rural populations, and people with disabilities) are present as the Agency is developing, implementing, and evaluating its programs and policies. Vision All CMS beneficiaries have achieved their highest level of health, and disparities in health care quality and access have been eliminated.
CMS Equity Plan for Medicare • A four-year strategic plan that includes six priority areas • First CMS plan to address health equity in Medicare • Identifies multilevel solutions to reduce disparities in Medicare. • Read the CMS Equity Plan for Medicare at go.cms.gov/cms-omh
Equity Plan Priority Areas Priority 4 : Increase the Ability Priority 1: Expand the Collection, of the Health Care Workforce Reporting, and Analysis of to Meet the Needs of Standardized Data Vulnerable Populations Priority 2 : Evaluate Disparities Priority 5 : Improve Impacts and Integrate Equity Communication & Language Solutions Across CMS Programs Access for Individuals with LEP & Persons with Disabilities Priority 3 : Develop and Priority 6 : Increase Physical Disseminate Promising Accessibility of Health Care Approaches to Reduce Health Facilities Disparities
Mapping Medicare Disparities (MMD) Tool Interactive Released in March 2016 Can be accessed here: https://www.cms.gov/about-cms/agency- information/omh/OMH-Mapping-Medicare-Disparities.html
MMD Tool Measures • 100% 2012-2014 Medicare beneficiary fee-for-service claims • Prevalence CVD, Diabetes, Chronic Kidney Disease (CKD), Multiple Chronic Conditions (MCC) • Hospitalization Rates 18 different chronic conditions & MCC • Average Costs 18 different chronic conditions • Emergency Room Visit Rates • Avoidable Hospitalization Rates Diabetes Complications, Hypertension, Congestive Heart Failures, Pneumonia, and more • Cause-specific Mortality Rates Acute Myocardial Infarction and Heart Failure This tool can help you visualize disparities and develop targeted strategies to reduce the disparities between different racial and ethnic groups.
MMD Tool Features The MMD Tool allows comparison of chronic disease conditions between (diabetes example): State & national • Compare the cost of diabetes across states in the U.S. averages Geographic • Compare the cost of diabetes across different counties within a state regions Groups within the • Compare the cost of diabetes between men and same geographic women, different age groups, or between different racial and ethnic groups within a specific county area
MMD Tool Features The MMD Tool Can: • Enable visualization and cost/trend analysis of existing healthcare disparities, which are linkable at the national, state, or county level • Aid development of targeted research to quickly calculate disparities existing between different racial groups • Increase access to risk-adjusted cost, readmission, and prevention quality indicator measures to study healthcare cost and quality rates
MMD Tool Features The MMD Tool Can: • Provide a resource for researchers to easily identify, view, and download, and analyze data on the health issues in their area and gauge change in those issues over time • Provide a resource for government agencies, health policy makers, researchers, and members of the general public with an interest in health disparities
Example Disparities in Diabetes Costs Which counties in New Mexico have the largest discrepancies in diabetes costs among Hispanic populations when compared to state diabetes costs among Hispanic populations? Union County (NM) The cost of diabetes among County Hispanic Total Cost: $18,201 New Mexico Hispanic Total Cost: $12,001 Hispanics in Union County is 1.5 Difference in Total Cost: $6,200 times that of the statewide costs for Hispanics. The cost of diabetes among Hispanics in De Baca County is 1.3 De Baca County (NM) times that of the statewide costs County Hispanic Total Cost: $16,052 New Mexico Hispanic Total Cost: $12,001 for Hispanics. Difference in Total Cost: $4,051
Example Disparities in Diabetes Costs In New Mexico, what county has the largest with-in county difference in diabetes costs between racial and ethnic groups ? The average cost of diabetes Union County (NM) Hispanic Total Cost: $18,201 among Hispanics in Union County White Total Cost: $13,673 is 1.3 times that of White average Difference in Total Cost: $4,528 costs.
Example Reduce Preventable Admissions In Florida, which county has the highest disparities in rates for avoidable hospital admissions Okeechobee County (FL) Black Hospitalization: 40 per 1,000 beneficiaries for diabetes? White Hospitalization: 6 per 1,000 beneficiaries Difference in Hospitalization: 34 per 1,000 beneficiaries In Okeechobee County, the rate for avoidable hospital admissions for diabetes among African Americans is 6.7 times higher than the rate for Whites.
Download the Data Example – Diabetes Costs in Florida Counties, By Race & Ethnicity and Insurance Type Data can be downloaded and manipulated in Excel Average Total Cost per Beneficiary – Diabetes: Florida Counties, 2014 Dual & Non Dual Beneficiaries Medicare Only Beneficiaries Difference in cost Difference in cost County Black White Black White between Black and between Black and Beneficiaries Beneficiaries Beneficiaries Beneficiaries White Beneficiaries White Beneficiaries Lake $18,062 $13,244 $4,818 $13,083 $12,752 $331 Lee $17,187 $13,220 $3,967 $14,259 $12,632 $1,627 Leon $15,934 $12,903 $3,031 $11,706 $11,954 -$248 Levy $22,928 $14,448 $8,480 $13,604 $11,551 $2,053 Liberty $17,649 $11,941 $5,708 $10,149 $11,596 -$1,447 Madison $13,636 $11,549 $2,087 $10,574 $10,802 -$228 Manatee $19,738 $13,634 $6,104 $13,009 $12,619 $390 Marion $17,289 $13,573 $3,716 $12,968 $12,657 $311 Martin $17,693 $14,655 $3,038 $15,074 $14,108 $966 Miami-Dade $28,943 $18,588 $10,355 $19,606 $15,761 $3,845 Monroe $18,283 $14,539 $3,744 $14,772 $12,867 $1,905 Among selected Florida counties, Miami-Dade County has the Among selected Florida counties, the difference in costs largest discrepancy between Black and White populations in between Black and White Medicare beneficiaries differs by the total amount paid per beneficiary for diabetes. county. In Miami-Dade there are higher costs for black populations; the reverse is true in Liberty County.
Contact Us Madeleine Shea, Deputy Director, CMS OMH Madeleine.Shea@cms.hhs.gov CMS OMH Homepage: go.cms.gov/omh Join the List Serve Access resources and tools
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