Komodo Health Analysis Finds Geography and Insurance Type Drive Significant Variation in Preventive Screening Rates

No American’s zip code or tax bracket should determine the quality of care they receive, yet research consistently shows us that people routinely receive uneven treatment based on where they live and what type of insurance they carry. That hard fact has been proven again in the latest analysis conducted both by Komodo Health using its Healthcare Map™ and the CMS Medicare fee-for-service data set under the Centers for Medicare & Medicaid Services Qualified Entity Program (QECP). 

The new analysis tracks the extent to which individuals with schizophrenia or bipolar disorder in the United States who are treated with antipsychotics are receiving recommended annual screening for diabetes and other metabolic disorders. Despite the fact that this preventive screening is recommended for all patients with schizophrenia and bipolar disorder who are treated with antipsychotics due to their higher risk of developing type 2 diabetes, roughly one-quarter of patients (26%) do not receive it. Worse, that rate varies considerably based on the state in which the patient lives and the type of insurance they have.

To conduct the analysis, Komodo used a Healthcare Effectiveness Data and Information Set (HEDIS®) standard measure that was developed by experts and is endorsed by the National Quality Forum, and is reporting on measurement year 2018.

Following were some of the key findings:

• 74% of Patients Receive Necessary Screening: Overall, approximately 74% of patients with schizophrenia or bipolar disorder who were prescribed atypical antipsychotics were screened for diabetes sometime during the measurement year. This number is up two percentage points from the previous measurement year (2017).
• Medicare Advantage Patients Significantly Less Likely to Receive Screening: Screening rates varied significantly depending on the type of insurance coverage that a patient had. The highest increase in the rate of screening (74.5%) was seen in the group of patients in the Commercial-Private category. The lowest rate of screening (56.06%) was seen in the group of patients in the Medicare Advantage category.
• Patients in Puerto Rico and Alabama Least Likely to Receive Screening: Screening rates also varied significantly depending on a patient’s state or territory of residence. The report found a 14.2% difference between the region with the highest screening rate (Wyoming) and the region with the lowest screening rate (Puerto Rico). Other states and territories with particularly low screening rates were Alabama (67.7%), Hawaii (67.9%) and Colorado (69.0%).

Several factors may be influencing these trends. Among them, the report cites recent changes to Medicaid managed care contracts and reimbursement incentives for coordination of care in Medicaid-Medicare Dual and Medicaid Managed Care patients and geographical variations in practice patterns that are likely playing a significant role.

To view the full report, click here. 

To see more articles like this, follow Komodo Health on Twitter and LinkedIn, and visit Insights on our website.