# Finding Solutions for Disparities Associated with Star Ratings

> **NIH NIH R01** · UNIVERSITY OF TENNESSEE HEALTH SCI CTR · 2021 · $334,400

## Abstract

Established by the Centers for Medicare & Medicaid Services (CMS), Star Ratings system for Medicare Parts
C&D (Star Ratings, hereafter) is a health plan quality reporting system with associated bonus payments and
enrollment incentives for health plans since 2012. Researchers have reported the disparity implications of Star
Ratings: e.g., racial/ethnic minorities are more likely to be excluded from measure calculation for diabetes
adherence than non-Hispanic whites, thus minorities may be more likely to be excluded from quality
improvement initiations for this measure, potentially worsening disparities in health. A critical barrier for
resolving such disparities is that comprehensive policy recommendation related to effects of Star Ratings on
racial/ethnic disparities is not available. The goals of this project are to ensure that Star Ratings include a set
of measures that address disparities in measure calculation, and to evaluate the effects of Star Ratings bonus
payments on reducing racial/ethnic disparities in medication utilization. Our strategies are to (1) add to Star
Ratings medication utilization measures selected from Pharmacy Quality Alliance measure concept inventory
(PMCI), and other commonly used medication utilization (CUMU) measures (Star Plus, hereafter), and (2)
compare racial/ethnic disparities in medication utilization before and after the implementation of bonus
payments, and between counties with “double bonuses” and those with regular bonuses. A project focusing on
only medication utilization measures in Star Ratings is warranted because these measures account for a high
percentage in Star Ratings scores (45% in Part D in 2013) and their correlation with other measures is only
moderate. Bonus payments are associated with improved plan benefit structure, which may reduce
racial/ethnic disparities in medication utilization. In the prior grant period we found that selecting appropriate
medication utilization measures may resolve racial/ethnic disparities associated with a Medicare Part D policy.
Our objective of this continuation project is to conduct an analysis of Medicare Parts A/B/D data (2010-2015),
linked to Area Health Resources Files, Orange Book Data Files, and CMS data on double/regular-bonus
counties. We will also conduct disease-specific analysis. Aim 1: Test the hypothesis that using the medication
utilization measures in current Star Ratings negatively affects the health of racial/ethnic minorities. Aim 2: Test
the hypothesis that using Star Plus can lead to a reduction in racial/ethnic disparities associated with Star
Ratings. Aim 3: Test the hypothesis that the Star Ratings bonus payments are associated with reduction in
racial/ethnic disparities in medication utilization. Our expected outcome is to provide policy recommendations
to resolve important disparity issues in Star Ratings among diverse older adults. Impact: This project will help
to align disparity reduction goals with rapidly-proliferating pay-for-pe...

## Key facts

- **NIH application ID:** 10217951
- **Project number:** 5R01AG049696-07
- **Recipient organization:** UNIVERSITY OF TENNESSEE HEALTH SCI CTR
- **Principal Investigator:** Junling None Wang
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $334,400
- **Award type:** 5
- **Project period:** 2015-08-15 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10217951

## Citation

> US National Institutes of Health, RePORTER application 10217951, Finding Solutions for Disparities Associated with Star Ratings (5R01AG049696-07). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10217951. Licensed CC0.

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