Incentivizing excellent care to at-risk groups with a health equity summary score
Open accessAbstract
Background Social risk factors (SRFs) such as minority race-and-ethnicity or low income are associated with quality-of-care, health, and healthcare outcomes. Organizations might prioritize improving care for easier-to-treat groups over those with SRFs, but measuring, reporting, and further incentivizing quality-of-care for SRF groups may improve their care. Objective To develop, as a proof-of-concept, a Health Equity Summary Score (HESS): a succinct, easy-to-understand score that could be used to promote high-quality care to those with SRFs in Medicare Advantage (MA) health plans, which provide care for almost twenty million older and disabled Americans and collect extensive quality measure and SRF data. Design We estimated, standardized, and combined performance scores for two sets of quality measures for enrollees in 2013-2016 MA health plans, considering both current levels of care, within-plan improvement, and nationally benchmarked improvement for those with SRFs (specifically, racial-and-ethnic minority status and dual-eligibility for Medicare and Medicaid). Participants All MA plans with publicly reported quality scores and 500 or more 2016 enrollees. Main measures Publicly reported clinical quality and patient experience measures. Key results Almost 90% of plans measured for MA Star Ratings received a HESS; plans serving few patients with SRFs were excluded. The summary score was moderately positively correlated with publicly reported overall Star Ratings (r = 0.66-0.67). High-scoring plans typically had sizable enrollment of both racial-and-ethnic minorities (38-42%) and dually eligible beneficiaries (29-38%). Conclusions We demonstrated the feasibility of developing and estimating a HESS that is intended to promote and incentivize excellent care for racial-and-ethnic minorities and dually eligible MA enrollees. The HESS measures SRF-specific performance and does not simply duplicate overall plan Star Ratings. It also identifies plans that provide excellent care to large numbers of those with SRFs. Our methodology could be extended to other SRFs, quality measures, and settings.
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Scales or items developed to measure experiences of care with a health equity lens often focus primarily on racialized groups and groups experiencing financial strain.
“Scales or items developed to measure experiences of care that strive to use a health equity lens often focus primarily on racialized groups (e.g., based on a mix of geographic origin, skin colour, and identity), and on groups experiencing financial strain [14, 17, 18].”
From Using a health equity lens to measure patient experiences of care in diverse health care settings (2024) · cites this paper as [18]
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Using a health equity lens to measure patient experiences of care in diverse health care settings
Browne, A. J., Varcoe, C., Ford-Gilboe, M., Wathen, C. N., Wilson, E., Bungay, V., & Perrin, N. (2024) · PLOS ONE · doi:10.1371/journal.pone.0297721 · Cited by 17 · see citing works
- Authors
- Agniel, D., Martino, S. C., Burkhart, Q., Hambarsoomian, K., Orr, N., Beckett, M. K., James, C., Scholle, S. H., Wilson-Frederick, S., Ng, J., & Elliott, M. N.
- Affiliations
- RAND Corporation (US)
- Centers for Medicare and Medicaid Services (US)
- National Committee for Quality Assurance (US)
- Corresponding author
- Elliott, Marc N.
- Venue
- Journal of General Internal Medicine
- Published
- 2019-11-11
- Volume
- 36
- Issue
- 7
- Pages
- 1847-1857
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC8298664
- OpenAlex
- W2984202484
- Cited by
- 36
- References
- 39
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 9 · 2021: 7 · 2020: 2
- FWCI
- 5.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Medicare and Medicaid Services (GS-10F-0012Y / HHSM-500-2016-00097G)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- health equity, social risk factors, Medicare Advantage, quality of care, racial and ethnic minorities, dual eligibility, quality metrics, star ratings, vulnerable populations
- MeSH terms
- Health Equity, Aged, Ethnicity, Humans, Minority Groups, Motivation, United States, Medicare Part C
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