The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64799

Robert S. Levine, MD¹, Nathaniel C. Briggs, MD, MSc¹, Baqar A. Husaini, PhD², Pamela C. Hull, PhD², Rubens J. Pamies, MD³, Susan Tropez-Sims, MD⁴, and Janice S. Emerson, MA². (1) Division of Preventive Medicine, Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd - Box 52A, Nashville, TN 37208, 615-327-6782, rlevine@mmc.edu, (2) Center for Health Research, Tennessee State University, Box 9580, 3500 John A. Merritt Blvd., Nashville, TN 37209, (3) Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN 37208, (4) Pediatrics, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN 37203

Eliminating health disparities is an overarching goal of Healthy People 2010 (HP2010) that will require the equitable delivery of preventive health services to all U.S. subpopulations. To monitor progress, performance measures have been developed, such as the National Committee for Quality Assurance (NCQA) Health Plan Employer Data and Information Set (HEDIS), which are linked to accreditation of managed care organizations and preferred provider organizations. However, if preventive needs coverage is inadequate, especially among underserved populations, these measures may perpetuate health disparities through covert rationing, whereby preventive services are limited to a least common denominator of “what’s measured gets done.” We assessed whether HEDIS Medicaid performance measures adequately covered preventive needs of a low-income, predominantly Medicaid-insured outpatient clinic population. Study participants comprised 987 patients ages (<=17=514, >=18=473), both sexes (Male=287, Female=701), and three race/ethnic groups (African American=687, White=173, Hispanic=88) seen in 2000-2001 at Meharry Medical College, Nashville, Tennessee. Preventive needs were quantified using recommendations of the 2nd United States Preventive Services Task Force (USPSTF). Overall, 10,645 USPSTF preventive needs were identified in the patient population, with 95% (10,065) incorporated into HP2010. HEDIS Medicaid covered only 23% (2,482/10,645) of overall needs; coverage was 78% (843/1080) for immunization needs, 35% (732/2,069) for screening and 13% (907/7,496) for counseling. Although preventive counseling accounted for 70% of patient needs, this dimenson of preventive services was almost completely overlooked by HEDIS Medicaid. These findings bode poorly for the HP2010 goal of eliminating health disparities, and may contribute to a widening mortality ratio for low-income patient populations.

Learning Objectives:

• Explain the role of preventive health services in achieving the goal of eliminating health disparities in the U.S., as set out under the Healthy People 2010 initiative; 2a. Define the purpose for which performance measures were developed; 2c. Identify the leading national organization involved in assessing performance of managed care organizations; 3a. Name the set of performance measures used to monitor delivery of preventive services to Medicaid recipients enrolled in managed care plans; 3b. Distinguish between types of preventive services that are and are not well covered by this set of performance measures;
• Explain why health disparities can be perpetuated, and exacerbated, if performance measures with limited coverage of necessary preventive services become tied to financial interests of corporate healthcare entities

Keywords: HEDIS, Underserved Populations

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.