Four ways MCOs can reduce health disparities in patients with disabilities

Individuals with disabilities experience healthcare disparities, according to a new study published in the Annals of Family Medicine.

Researchers at The Ohio State University Wexner Medical Center’s Nisonger Center found significant disparities between individuals with and without developmental disabilities in health status, healthcare quality, utilization, access to care and unmet healthcare needs.

A telephone survey of 42,876 adults and 10,122 proxy interviews for children found that, when comparing age groups, children and older adults with developmental disabilities experienced the greatest disparities in unmet healthcare needs.

Researchers conducted a retrospective cross-sectional analysis of the 2015 Ohio Medicaid Assessment Survey (OMAS).

Key findings:

· Among children zero to 18 years of age with developmental disabilities, 14% reported problems receiving needed care, compared to 2% of children without developmental disabilities.

· Among adults age 65 years and older, 50% of those with developmental disabilities reported one or more unmet healthcare needs, compared to 17% of those without such disabilities. 

Prokup

“Furthermore, these disparities begin in childhood and continue throughout the lifespan, often worsening with age,” says Jessica Prokup, a third-year medical student at Ohio State’s College of Medicine and Leadership Education in Neurodevelopmental Disabilities fellow at the Nisonger Center, which is part of Ohio State’s Neurological Institute.

“Few studies quantify the health disparities experienced by adults with developmental disabilities,” Prokup says. “There is a distinct need for studies that examine these health disparities in this vulnerable population throughout the lifespan.”

Next: Findings broken down by age group

Findings for pediatric patients

The researchers found that children (zero to 18 years) with developmental disabilities were 25 times more likely to have a fair or poor health status than children without developmental disabilities. The greatest disparities in unmet prescription and other healthcare services occurred between children with and without developmental disabilities.

In addition, children with developmental disabilities were over three times as likely to have one or more unmet health need as children without developmental disabilities.

Findings for young adults

People with developmental disabilities in the healthcare transition (HCT) age group (age 19 to 30 years) were the least likely to report having enough time with their primary care physicians (PCP). Young adults with developmental disabilities in HCT were significantly more likely to report having problems getting needed care than young adults without developmental disabilities.

Young adults with developmental disabilities were also almost twice as likely to report problems seeing a specialist as young adults without developmental disabilities. Young adults with developmental disabilities were twice as likely to have one or more unmet health need as young adults without developmental disabilities.

Findings for middle-aged patients

Adults age 31 to 64 years with developmental disabilities experienced problems accessing needed healthcare services at a rate almost five times higher than adults without developmental disabilities.

Adults with developmental disabilities also experienced the greatest unmet dental, vision, and prescription needs. Additionally, adults with developmental disabilities were more than twice as likely to have difficulties accessing specialty care as adults without developmental disabilities.

Adults with developmental disabilities were also more than twice as likely to report one or more unmet health need as adults without developmental disabilities.

Findings for elderly patients

According to the study, the greatest dental and vision disparities occurred among adults older than age 65 with developmental disabilities. Older adults with developmental disabilities were more than three times as likely to report problems seeing a specialist as those without developmental disabilities.

Older adults with developmental disabilities were more than seven times as likely to report problems obtaining needed care compared to older adults without developmental disabilities. Older adults with developmental disabilities were the least likely to have PCPs that usually or always explain education well. Older adults with developmental disabilities were three times as likely to have one or more unmet health need compared to older adults without developmental disabilities.

Next: Four tips for MCOs

Lessons for MCOs

“Managed care executives should be aware of the high rate of unmet healthcare needs for people with developmental disabilities across the lifespan,” says Susan M. Havercamp, director, Health Promotion and Healthcare Parity Program at the Nisonger Center. “Although this study did not compare health insurance plans, previous research suggests that people with developmental disabilities benefit from provisions such as health homes, care coordination, and transportation to and from healthcare appointments.”

The researchers identified four things that managed care executives can do to reduce disparities between individuals with and without developmental disabilities:

1. Evaluate how satisfied patients with developmental disabilities are with their care.

Prokup says survey questions should target:

· Quality of care ( physicians spending enough time with the patient, physicians explaining things well to the patient;

· Access to care (does the patient have a usual source of care? Does the patient have problems getting needed care? Does the patient have problems receiving same-day care for urgent health needs? Does the patient have problems seeing a specialist?); and

· Unmet healthcare needs (vision, dental, prescription).

2. Evaluate the survey findings to determine the unmet needs and barriers to care.

3. Interview patients with disabilities and experts in the field of disabilities (i.e., the American Academy of Developmental Medicine & Dentistry) to determine how best to overcome these barriers.

Potential barriers to anticipate needing to address include:

· Transportation

· Flexibility of office schedules

· Staff’s willingness to adapt to patients’ unique needs

· Staff education on disabilities

· Financial challenges

· Structural barriers

4. Ask patients with developmental disabilities what they need and be willing to make the changes necessary to help them.

“This by far is the number one thing you can do,” Prokup says.