Black and Latinx patients left out of federal health program meant to improve care

A federal program aimed at improving health among Medicare patients is bypassing Black and Latinx patients, according to a new study by researchers at UC Berkeley School of Public Health and UCSF.

The Comprehensive Primary Care Plus (CPC+) program was designed to improve the quality of care and reduce medical costs for adult patients with chronic conditions, particularly those who are Medicare beneficiaries. Run by the Centers for Medicare and Medicaid Services, CPC+ paid primary care physician groups to adopt certain practices to improve patient care. By 2021, 11,718 primary care practices had enrolled.

But, in a study published March 20 in the Journal of General Internal Medicine, the researchers wrote that CPC+ selection criteria and recruitment efforts were largely omitting primary care practices who serve large numbers of Black and Latino patients.

“We found that the practices that are participating in the CPC+ program are practices that have low shares of Black and Latino beneficiaries,” said Karl Rubio, a senior data analyst with the Center for Healthcare Organization and Innovation Research, and lead author of the study. “It’s not intentional, but the program is missing the target.”

The authors write that past research, along with their own findings, suggest that primary care practices with high concentrations of Black and Latino patients tend to be smaller than those that cater to white patients; have limited electronic record capacities, and have had less participation in programs to transform their practices—all prerequisites for participation.

“If you are not invited to have a seat at the table because you don’t have certain capabilities as a practice, then you and your patients are being left out,” said Taressa K. Fraze, assistant professor of medicine at UCSF and a coauthor of the study.

“CPC+ says, ‘To do this, we want you to be a little bigger, because you’ll have more resources, and we want you to be in this century in terms of technology.’ That seems totally reasonable when you put it like that. They want to set the practices up for success,” she said. “But the result is that the very practices and patients who could benefit the most from a program like CPC+, because they provide financial support, are left out.”

The authors note that the CPC+ program has led to improvements in primary care delivery and reductions in emergency room visits. They also write that Medicare patients who went to CPC+ practices reported better primary care experiences than those who visited non-participating practices.

As the Biden administration considers other proposals to promote equity and reduce barriers from structural racism in medical care, the authors say, “special attention should be given to the racial and ethnic diversity of beneficiaries of enrolled practices to ensure that federally sponsored practice transformation resources can advance racial equity, while improving overall quality and managing total spending.”

Additional authors: Salma Bibi and Hector P. Rodriguez, Division of Health Policy and Management, UC Berkeley School of Public Health.


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