title: The role of data in health care disparities in Medicaid managed care.
abstract: BACKGROUND
  The Affordable Care Act includes provisions to standardize the collection of data on health care quality that can be used to measure disparities. We conducted a qualitative study among leaders of Medicaid managed care plans, that currently have access to standardized quality data stratified by race and ethnicity, to learn how they use it to address disparities.
  
  
  METHODS
  We conducted semi-structured interviews with 21 health plan leaders across 9 Medicaid managed care plans in California. We used purposive sampling to maximize heterogeneity in geography and plan type (e.g., non-profit, commercial). We performed a thematic analysis based on iterative coding by two investigators.
  
  
  RESULTS
  We found 4 major themes. Improving overall quality was tightly linked to a focus on standardized metrics that are integral to meeting regulatory or financial incentives. However, reducing disparities was not driven by standardized data, but by a mix of factors. Data were frequently only examined by race and ethnicity when overall performance was low. Disparities were attributed to either individual choices or cultural and linguistic factors, with plans focusing interventions on recently immigrated groups.
  
  
  CONCLUSIONS
  While plans' efforts to address overall quality were often informed by standardized data, actions to reduce disparities were not, at least partly because there were few regulatory or financial incentives driving meaningful use of data on disparities. Standardized data, as envisaged by the Affordable Care Act, could become more useful for addressing disparities if they are combined with policies and regulations that promote health care equity.
authors.affiliation: Alameda County Medical Center.
authors.forename: David
authors.initials: D
authors.lastname: Moskowitz
authors.affiliation: University of Dundee.
authors.forename: Bruce
authors.initials: B
authors.lastname: Guthrie
authors.affiliation: University of California San Francisco.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Bindman
mesh_terms: D002140:California / Q000453:epidemiology; D005006:Ethnicity; D054625:Healthcare Disparities / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data*; D036301:Qualitative Research; D044469:Racial Groups; D014481:United States / Q000453:epidemiology
keywords: Ethnic Differences in Health and Health Care; Health Policy; Law; Politics; Regulation, Medicaid, Qualitative Research, Racial