Addressing Racial and Ethnic Disparities in the Context of
Medicaid Managed Care: A Six-State Demonstration Project

Conclusions

The model being tested here is clearly generalizable to other state Medicaid programs (at least to those that have reasonably complete and accurate race/ethnicity data and can provide that data to plans in a format that allows for integration with health plan membership files) and to Medicare+Choice plans. State Medicaid programs were able to provide data on race/ethnicity to managed care plans, and with relatively few and minor exceptions, plans were able to analyze HEDIS data and identify disparities, organize QI projects to reduce or eliminate disparities, and assess the effects of those interventions. Some of the initiatives were able to produce reductions in disparities or improvements in quality for target minority groups within one cycle of follow-up data analysis. Based on early experience in the project, the State of Michigan has already begun to expand the project from the original three participating plans to most of the managed care plans involved in Medicaid.

This approach may also serve as a model for the private sector if employers are willing and able to provide race/ethnicity data on employees to managed care plans. If commercial health plans are able to obtain data on members’ race/ethnicity directly from members or through other means, then the sequence of steps being followed in this project, from initial data analysis, to identification of disparities, to planning and implementing of QI projects, to assessment of impact of those projects, can be followed by commercial plans just as easily as by public sector plans.

The QI projects represented a diverse and interesting mix of patient education, provider education or reminder, disease management, and system improvement interventions. Clinical target areas include diabetes care, prenatal care, and well-child care. Health plans and state Medicaid programs should find useful ideas and models to follow as they organize similar disparities initiatives.

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