Department of Public Health Policy and Management, School of Global Public Health, New York University, New York.
Healthcare Coverage and Access, The Commonwealth Fund, New York, New York.
JAMA Netw Open. 2024 Jul 1;7(7):e2424089. doi: 10.1001/jamanetworkopen.2024.24089.
The star rating of a Medicare Advantage (MA) plan is meant to represent plan performance, and it determines the size of quality bonuses. Consumer access to MA plans with a high star rating may vary by the extent of social vulnerability in geographic regions.
To examine the association between a county's Social Vulnerability Index (SVI) and the star rating of a county's MA plans.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2023 Centers for Medicare & Medicaid Services data for all MA plans linked to 2020 county-level SVI data from the Centers for Disease Control and Prevention. Data were analyzed from March to October 2023.
Quintile rank of county based on composite and theme-specific SVI scores, with quartile 1 (Q1) representing the least vulnerable counties and Q5, the most vulnerable counties. The SVI is a multidimensional measure of a county's social vulnerability across 4 themes: socioeconomic status, household characteristics (such as disability, age, and language), racial and ethnic minority status, and housing type and transportation.
County-level mean star rating and the number of MA plans with low-rated (<3.5 stars), high-rated (3.5 or 4.0 stars), and highest-rated (≥4.5 stars) plans.
Across 3075 counties, the median county-level star rating was 4.1 (IQR, 3.9-4.3) in Q1 counties and 3.8 (IQR, 3.6-4.0) in Q5 counties (P < .001). The mean star rating of MA plans was lower (difference, -0.24 points; 95% CI, -0.28 to -0.21 points; P < .001), the number of low-rated plans was higher (incidence rate ratio, 1.81; 95% CI, 1.61-2.06; P < .001), and the number of highest-rated plans was lower (incidence rate ratio, 0.75; 95% CI, 0.70-0.81; P < .001) in Q5 counties compared with Q1 counties. Similar patterns were found across theme-specific SVI score quintiles and for 2022 star ratings.
In this cross-sectional study, the most socially vulnerable counties were found to have the fewest highest-rated plans for MA beneficiaries. As MA enrollment grows in socially vulnerable regions, this may exacerbate regional differences in health outcomes for Medicare beneficiaries.
医疗保险优势（MA）计划的星级旨在代表计划绩效，它决定了质量奖金的规模。消费者获得星级较高的 MA 计划的机会可能因地理区域的社会脆弱性程度而异。
研究县的社会脆弱性指数（SVI）与该县 MA 计划星级之间的关联。
设计、地点和参与者：这项横断面研究使用了 2023 年医疗保险和医疗补助服务中心（CMS）的数据，这些数据与疾病控制和预防中心（CDC）的 2020 年县一级 SVI 数据相关联。数据于 2023 年 3 月至 10 月进行分析。
根据综合和主题特定 SVI 得分对县进行五分位排名，四分位 1（Q1）代表最脆弱的县，五分位 5（Q5）代表最脆弱的县。SVI 是一个多维度的衡量县在 4 个主题上的社会脆弱性的指标：社会经济地位、家庭特征（如残疾、年龄和语言）、种族和少数民族地位以及住房类型和交通。
县一级的平均星级评分和低评级（<3.5 星）、高评级（3.5 或 4.0 星）和最高评级（≥4.5 星）计划的 MA 计划数量。
在 3075 个县中，Q1 县的县一级平均星级评分中位数为 4.1（IQR，3.9-4.3），Q5 县为 3.8（IQR，3.6-4.0）（P<0.001）。MA 计划的平均星级评分较低（差异，-0.24 分；95%CI，-0.28 至-0.21 分；P<0.001），低评级计划数量较高（发病率比，1.81；95%CI，1.61-2.06；P<0.001），最高评级计划数量较低（发病率比，0.75；95%CI，0.70-0.81；P<0.001）在 Q5 县与 Q1 县相比。在特定主题的 SVI 五分位评分和 2022 年的星级评分中也发现了类似的模式。
在这项横断面研究中，发现社会最脆弱的县为 MA 受益人的最高评级计划数量最少。随着 MA 参保人数在社会脆弱地区的增长，这可能会加剧医疗保险受益人的健康结果在地区之间的差异。
