Online Program

Bridging quality of services between old and young: Developing a broad-spectrum measure of age-related disparities using CAHPS surveys within a large and diverse Medicaid health plan, 2006-2012

Wednesday, November 6, 2013

S. Rae Starr, MPhil, MOrgBehav, HealthCare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Medicaid programs in urban and rural areas face a unique challenge: They serve bi-modal patient populations composed of very young patients and their mothers, and also of elderly disabled patients. This means that health plans and public agencies face the task of creating healthcare systems that include providers with the skillsets to cover pediatric patients, and other providers who cover gerontological needs.

(1) Design: CAHPS surveys allow for surveying adults, and separately surveying and parents of pediatric patients. Many health plans simultaneously field both surveys, so CAHPS is uniquely suited to compare the quality of services delivered to old and young. A difference index is calculated to show disparities or strengths in terms of breadth-of-capabilities. This index can be used to compare healthcare systems' performance across age demographics.

(2) Setting: The presentation uses CAHPS data from a large, diverse, urban Medicaid health plan from 2006 to 2012.

(3) Analysis: The index is a simple arithmetic difference between adult and child scores wherever the two surveys share a substantively comparable measure. Properties of the measure are reported using real world data.

(4) Uses: The presentation discussions potential extensions of the measure to provider groups, to determine which provider groups are best-suited for contracting to serve both age cohorts. Costs, limitations, pitfalls, and appropriate uses of the measure are discussed.

(5) Discussion: The briefing discusses potential benefits to patients, health plans, and providers, of using a bread-of-capabilities measure in selecting providers suited to patients at both ends of the life spectrum.

Learning Areas:

Biostatistics, economics
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
Explain the challenges in Medicaid services in contexts where patrons are mainly very young or older and disabled. Describe how that diverse membership impacts contracting of provider groups to cover gerontological and pediatric skillsets. Discuss why CAHPS surveys are uniquely suited for making comparisons for detecting disparities. Design a measurement strategy to calculate a disparities index or breadth-of-capabilities index, using CAHPS Adult and Child surveys. Discuss how to use the index to report how a healthcare system is serving both groups: older and younger patients. Analyze how that disparities index performs in the real world context of a large urban Medicaid health plan. Describe how to extend that measurement strategy to provider group surveys for aid in contracting decisions. Evaluate how such a disparities index can be used to help old and young patients end up with provider groups that have a good fit to those patients' needs. Explain the costs and work, and limitations and pitfalls entailed in using a disparities measure to improve services. Discuss potential uses of the index, and the benefits to patients, health plans, and providers.

Keyword(s): Aging, Member Surveys

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Served seven years as Senior Biostatistician at the largest U.S. public health plan, serving Medicaid and CHIP populations in an ethnically diverse urban county in the southwest United States. Managed CAHPS survey from 2006 to 2013 to obtain actionable information to guide design of interventions to improve the quality of services and care. Designed analytic plans for studying the needs of seniors and other special populations, to guide programs and projects.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.