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When the Process Is the Problem: Racial/Ethnic and Language Disparities in Care Management



Achieving health equity requires addressing disparities at every level of care delivery. Yet, little literature exists examining racial/ethnic disparities in processes of high-risk care management, a foundational tool for population health. This study sought to determine whether race, ethnicity, and language are associated with patient entry into and service intensity within a large care management program.


Retrospective cohort study.


Subjects were 23,836 adult patients eligible for the program between 2015 and 2018. Adjusting for demographics, utilization, and medical risk, we analyzed the association between race/ethnicity and language and outcomes of patient selection, enrollment, care plan completion, and care management encounters.


Among all identified as eligible by an algorithm, Asian and Spanish-speaking patients had significantly lower odds of being selected by physicians for care management [OR 0.74 (0.58–0.93), OR 0.79 (0.64–0.97)] compared with White and English-speaking patients, respectively. Once selected, Hispanic/Latino and Asian patients had significantly lower odds compared to White counterparts of having care plans completed by care managers [OR 0.69 (0.50–0.97), 0.50 (0.32–0.79), respectively]. Patients speaking languages other than English or Spanish had a lower odds of care plan completion and had fewer staff encounters than English-speaking counterparts [OR 0.62 (0.44–0.87), RR 0.87 (0.75–1.00), respectively].


Race/ethnicity and language-based disparities exist at every process level within a large health system’s care management program, from selection to outreach. These results underscore the importance of assessing for disparities not just in outcomes but also in program processes, to prevent population health innovations from inadvertently creating new inequities.

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Data Availability

The datasets generated and analyzed during the current study are not publicly available as they may contain sensitive patient information and proprietary program information from Mass General Brigham. The data may be available on reasonable request from the corresponding author [P.G.W.] and with permission of Mass General Brigham.


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Contributors: The authors would like to thank Dr. Joseph Betancourt and the Massachusetts General Hospital Disparities Solution Center for input on disparities solutions and Dr. John Orav for input on the statistical analysis plan in this study.

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Authors and Affiliations



All authors contributed to the study conception and design. Data collection and analysis were performed by Michelle Manaskie, MPH, and Priscilla Wang, MD, MPH. The first draft of the manuscript was written by Priscilla Wang, MD, MPH, and all authors commented on subsequent versions of the manuscript preceding publication. All authors read and approved the final manuscript.

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Correspondence to Priscilla G. Wang.

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Jack Rowe is employed by and has equity in the company agilon health. All other authors have no conflicts of interest to disclose.

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Wang, P.G., Rowe, J.S., Manaskie, M. et al. When the Process Is the Problem: Racial/Ethnic and Language Disparities in Care Management. J. Racial and Ethnic Health Disparities (2022).

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  • Care management
  • Disparity
  • Equity
  • Race
  • Language
  • Population health