Resolving Racial/Ethnic Disparities Associated with Star Ratings among the ADRD Population

Compared to their counterparts without Alzheimer’s disease and related dementias (ADRD), Medicare beneficiaries with ADRD are 2.8 times more likely to have multiple (≥4) coexisting chronic conditions and are more likely to experience poorer control of those conditions. These issues are more pressing for racial/ethnic minorities because, e.g., Blacks and Hispanics are 1.5-2 times more likely to have ADRD than non-Hispanic Whites (Whites). However, a critical barrier for rectifying racial/ethnic disparities in the ADRD population is the dearth of evidence to support strategy deliberation. The Centers for Medicare & Medicaid Services (CMS) developed Parts C & D Star Ratings (Star Ratings, hereafter) with associated bonus payments implemented in 2012. Star Ratings has excellent potential to improve chronic disease control because the Star Ratings summary score is predominantly based on medication utilization for chronic conditions. However, supported by our Parent R01, we reported that racial/ethnic minorities had a lower odds than Whites of being included in the calculations of medication utilization measures in Star Ratings. Thus, Star Ratings may aggravate racial/ethnic disparities in patient outcomes. Unfortunately, an ADRD-specific analysis was not proposed in our parent R01 because of our small sample size. With our newly-approved access to 100% Medicare data, we propose to examine/resolve disparities in Star Ratings among Medicare’s ADRD population. CMS continuously modifies the measure composition in Star Ratings to optimize quality assessment. Our study will thus help CMS continue making informed measure adjustments. A project analyzing only medication utilization measures is warranted also because the correlation of medication utilization and other measures in Star Ratings is only moderate. Our strategies are to determine whether an alternative program (Star Plus), including additional medication utilization measures developed by the Pharmacy Quality Alliance (PQA), can reduce disparities in Star Ratings among Medicare’s ADRD population. This is plausible because some PQA measures have more relaxed inclusion criteria in calculations than existing measures in Star Ratings. PQA is an organization established to develop/maintain medication utilization measures for Medicare. Aim 1: Test the hypothesis that racial/ethnic minorities are less likely to be included in the calculations of medication utilization measures in Star Ratings among Medicare’s ADRD population. Aim 2: Test the hypothesis that using the current medication utilization measures in Star Ratings worsens race/ethnic disparities in health outcomes among Medicare’s ADRD population. Examples of outcome measures are utilization/costs of preventable hospitalizations. Aim 3: Test the hypothesis that using Star Plus reduces disparities in Star Ratings among Medicare beneficiaries with ADRD. Impact: This project will resolve disparities in health outcomes associated with Star Ratings among the ADRD population and stimulate studies on similar policies. It will also assist NIA in achieving its strategic goals of “understand[ing]…” and “address[ing] racial[/]ethnic…disparities…among [the] ADRD population…”