We found higher community levels of economic distress were associated with greater illness burden and higher per-capita expenditures; lower use of flu shots, AWV, and TCM; and greater ACP use. Overall, receipt of these recommended services was dismal—for only one measure were use rates above 50%, on average: flu shots among the most economically advantaged ZIP codes.
Our work expands on that of Ganguli et al.,5 who found AWVs were less commonly received by minorities and those eligible for Medicaid. Our consideration of community-level economic distress may help providers target populations in need, where (our findings suggest) there may be multiple opportunities to improve care delivery.
Because two of the interventions we examined (TCM and AWV) appear to generate cost-offsets, outcomes improvement, and value creation,2, 3 their use should be encouraged by the Centers for Medicare and Medicaid Services (CMS). In particular, given its recent interest in funding efforts to address social determinants of health in the pursuit of better health outcomes, CMS might consider incentivizing health systems and providers to improve performance in communities with high economic distress levels, where healthcare costs are highest and, therefore, might have the greatest cost-offset impact.
Our study is limited by its reliance on administrative data, cross-sectional nature, and focus on the Medicare FFS population. Our findings suggest that providers, health systems, and policy makers should explore sources of the observed service use disparities and develop interventions that would improve the rate of provision of these services to Medicare beneficiaries living in the most economically distressed communities.