African-Americans who buy Medicare Advantage fare worse

(Reuters Health) - Medicare Advantage insurance plans may be creating a disadvantage for black patients who need major surgery, a new study suggests.

In New York State, where the study was done, black seniors on traditional Medicare were 33 percent more likely than whites to be readmitted to hospitals within a month of surgery, researchers found. Moreover, the disparity nearly doubled for black seniors covered by the more expensive and supposedly superior Medicare Advantage.

Blacks covered under private Medicare Advantage plans were 64 percent more likely than whites to be readmitted to hospitals within a month of surgery, according to the report in Health Affairs.

Medicare beneficiaries pay additional premiums for Medicare Advantage programs – commercial insurance plans touted as offering comprehensive disease management and care coordination to help seniors manage health conditions.

“Medicare Advantage has not been successful in reducing the readmission rate for black beneficiaries,” lead author Yue Li, a health policy professor at the University of Rochester Medical Center in New York, said in a phone interview. “What are the mechanisms? I don’t know for sure.”

The study analyzed data from 13,703 patients with traditional Medicare and 6,632 with Medicare Advantage plans who underwent one of six types of major surgeries in New York in 2013. All were 65 and older; the average age was 66.

Overall, 30-day readmission rates were almost identical for traditional Medicare and Medicare Advantage patients: 13.2 percent among Medicare patients and 13.1 percent among Medicare Advantage patients.

For whites, Medicare Advantage reduced the likelihood of 30-day hospital readmission rates by more than 12 percent over traditional Medicare. For blacks, however, Medicare Advantage increased the odds of readmission by nearly 11 percent over traditional Medicare, the study found.

Dr. Joseph Betancourt, who directs The Disparities Solutions Center at Massachusetts General Hospital in Boston and was not involved with the new study, expected to see racial disparities in hospital readmissions. But the fact that the disparities were nearly twice as large for black Medicare Advantage patients compared to traditional Medicare patients surprised him.

“That gap’s pretty big,” he said in a phone interview. “So there’s something significant going on here. Now we need to figure out why is it worse – counterintuitively – if you have Medicare Advantage.”

Since Medicare was established in the U.S. more than 50 years ago, disparities in health outcomes have persisted between whites and blacks, prior studies have shown.

But the new report is the first to examine the impact of Medicare Advantage on the disparities, Li said. Medicare Advantage data is not generally available to researchers, but New York State granted access to Li and his colleagues.

“The great unknown is why do we see greater disparities in Medicare Advantage than in traditional Medicare,” Betancourt said. “The government is expecting if you get people into Medicare Advantage the readmission rate will be lower.”

“But as we move people toward Medicare Advantage, African-Americans have worse outcomes,” he said.

Though most people in the U.S. over age 65 receive health coverage through traditional Medicare, 31 percent were enrolled in private Medicare Advantage plans in 2015, the authors write.

In spite of financial incentives for Medicare Advantage plans to prevent unnecessary hospital admissions, previous research shows mixed results when comparing the two programs’ readmission rates.

Betancourt believes racial disparities could arise from challenges around communication, trust and health literacy when patients are discharged.

“These issues impact all populations, but they impact some more than others. It’s not just what happens in the hospital. Once they leave the hospital, do they have the services they need?” he asked.

“We can’t do one-size fits all,” he said. “We need to tailor our discharge process to meet the needs of diverse patient populations.”

SOURCE: Health Affairs, online June 21, 2017.