ArticleHealth services research2023
Income-related disparities in Medicare advantage behavioral health care quality.
Article in Health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Prior Authorization Requirements in Medicare Advantage and County Social Vulnerability.The American journal of managed care · 2026Article
- The link between emotional health and organizational performance in the healthcare sector: a policy- and management-oriented perspective on psychological risks, organizational behavior, and service quality.Frontiers in psychology · 2026Article
- No Improvement In Mental Health Treatment Or Patient-Reported Outcomes At Medicare ACOs For Depression And Anxiety Disorders.Health affairs (Project Hope) · 2023Article
- Income-related disparities in Medicare advantage behavioral health care quality.Health services research · 2023Article
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
objectiveTo inform efforts to improve equity in the quality of behavioral health care by examining income-related differences in performance on HEDIS behavioral health measures in Medicare Advantage (MA) plans. DATA SOURCES AND STUDY
settingReporting Year 2019 MA HEDIS data were obtained and analyzed. STUDY
designLogistic regression models were used to estimate differences in performance related to enrollee income, adjusting for sex, age, and race-and-ethnicity. Low-income enrollees were identified by Dual Eligibility for Medicare and Medicaid or receipt of the Low-Income Subsidy (DE/LIS). Models without and with random effects for plans were used to estimate overall and within-plan differences in measure performance. Heterogeneity by race-and-ethnicity in the associations of low-income with behavioral health quality were examined using models with interaction terms. DATA COLLECTION/EXTRACTION
methodsData were included for all MA contracts in the 50 states and the District of Columbia that collect HEDIS data. PRINCIPAL
findingsFor six of the eight measures, enrollees with DE/LIS coverage were more likely to have behavioral health conditions that qualify for HEDIS measures than higher income enrollees. In mixed-effects logistic regression models, DE/LIS coverage was associated with statistically significantly worse overall performance on five measures, with four large (>5 percentage point) differences (-7.5 to -11.1 percentage points) related to follow-up after hospitalization and avoidance of drug-disease interactions. Where the differences were large, they were primarily within-plan rather than between-plan. Interactions between DE/LIS and race-and-ethnicity were statistically significant (p < 0.05) for all measures; income-based quality gaps were larger for White enrollees than for Black or Hispanic enrollees.
conclusionsLow income is associated with lower performance on behavioral health HEDIS measures in MA, but these associations differ across racial-and-ethnic groups. Improving care integration and addressing barriers to care for low-income enrollees may improve equity across income levels in behavioral health care.
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