Gender Disparities in Cardiovascular Disease Care Among Commercial and Medicare Managed Care Plans

Chou, Ann F.; Wong, Lok; Weisman, Carol S.; Chan, Sophia; Bierman, Arlene S.; Correa-de-Araujo, Rosaly; Scholle, Sarah Hudson

doi:10.1016/j.whi.2007.03.004

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Volume 17, Issue 3 , Pages 139-149, May 2007

Gender Disparities in Cardiovascular Disease Care Among Commercial and Medicare Managed Care Plans

Ann F. Chou, PhD, MPH
- Department of Health Administration and Policy, College of Public Health and College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
Lok Wong, MHS
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Carol S. Weisman, PhD
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
Sophia Chan, PhD
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Arlene S. Bierman, MD, MS
- Faculties of Medicine and Nursing, University of Toronto and Centre for Inner City Health Research, St. Michael’s Hospital, Toronto, Ontario, Canada
Rosaly Correa-de-Araujo, MD, MSc, PhD
- Office of the Americas, Office of the Secretary, Office of Global Health Affairs, Rockville, Maryland
Sarah Hudson Scholle, DrPH, MPH
- The National Committee for Quality Assurance, Washington, DC
- Correspondence to: Sarah Hudson Scholle, The National Committee for Quality Assurance, 2000 L St., Suite 500, Washington, DC 20036.

Received 12 January 2007; accepted 22 March 2007. published online 10 May 2007.

Background

Gender disparities in cardiovascular care have been documented in studies of patients, but little is known about whether these disparities persist among managed health care plans. This study examined 1) the feasibility of gender-stratified quality of care reporting by commercial and Medicare health plans; 2) possible gender differences in performance on prevention and treatment of cardiovascular disease in US health plans; and 3) factors that may contribute to disparities as well as potential opportunities for closing the disparity gap.

Methods

We evaluated plan-level performance on Healthcare Effectiveness Data and Information Set (HEDIS^®) measures using a national sample of commercial health plans that voluntarily reported gender-stratified data and for all Medicare plans with valid member-level data that allowed the computation of gender-stratified performance data. Key informant interviews were conducted with a subset of commercial plans. Participating commercial plans in this study tended to be larger and higher performing than other plans who routinely report on HEDIS performance.

Results

Nearly all Medicare and commercial plans had sufficient numbers of eligible members to allow for stable reporting of gender-stratified performance rates for diabetes and hypertension, but fewer commercial plans were able to report gender-stratified data on measures where eligibility was based on recent cardiac events. Over half of participating commercial plans showed a disparity of ≥5% in favor of men for cholesterol control measures among persons with diabetes and persons with a recent cardiovascular procedure or heart attack, whereas no commercial plans showed such disparities in favor of women. These gender differences favoring men were even larger for Medicare plans, and disparities were not linked to health plan performance or region.

Conclusions and Discussion

Eliminating gender disparities in selected cardiovascular disease preventive quality of care measures has the potential to reduce major cardiac events including death by 4,785–10,170 per year among persons enrolled in US health plans. Health plans should be encouraged to collect and monitor quality of care data for cardiovascular disease for men and women separately as a focus for quality improvement.