Do Localized Disasters Impact Clinical Measures of Health Care Quality?

Objective

To describe the effect of geographically limited disasters on health plan (ie, contract) quality performance scores using a broad set of clinical quality and patient experience measures.

Study Design

Retrospective analyses to assess the impact of disasters on Medicare Advantage contracts' quality-of-care performance scores in 2017 and 2018 for 11 Part C clinical quality and patient experience measures used in the Medicare Advantage Star Ratings.

Methods

We calculated each Medicare Advantage contract's disaster exposure using the percentage of the contract's beneficiaries residing in a Federal Emergency Management Agency-designated disaster area during the measurement period. Using linear mixed models, we estimated the association between contract-level disaster exposures and performance scores during the performance period measured, with random effects for contract and fixed effects for year, contract characteristics, and the disaster exposure, using repeated cross-sectional data on contracts from 2016 to 2018.

Results

We found no evidence that geographically limited disasters meaningfully affected contract quality performance scores. The disasters studied were associated with statistically significant but small changes in performance scores for 1 of 11 measures in both years.

Conclusions

The lack of evidence that being in a disaster-affected area had a meaningful negative impact on quality measure performance suggests that performance measurement programs are robust to the impact of short-term localized disasters and continue to function as intended.