November 2020

Rural-Urban Disparities 

in Health Care in Medicare 
ii
iii

Table ofContents

Executive Summary...................................................................................................................................... v 

Patient Experience and Clinical Care Measures Included in This Report................................................... xv

Abbreviations Used in This Report............................................................................................................xvii

Overview, Methods, and Summary of Results.............................................................................................1 

Section I: Rural-Urban Disparities in Health Care in Medicare.....................................................................6 

Rural-Urban Disparities in Care: All Patient Experience and Clinical Care Measures...............................7 

Patient Experience ...................................................................................................................................9 

Clinical Care: Prevention and Screening................................................................................................. 16

Clinical Care: Respiratory Conditions.....................................................................................................19

Clinical Care: Cardiovascular Conditions................................................................................................22

Clinical Care: Diabetes............................................................................................................................26

Clinical Care: Musculoskeletal Conditions..............................................................................................33

Clinical Care: Behavioral Health .............................................................................................................35

Clinical Care: Medication Management and Care Coordination............................................................42

Clinical Care: Overuse/Appropriateness ................................................................................................47

Clinical Care: Access/Availability of Care................................................................................................54

Section II: Rural-Urban Disparities in Health Care in Medicare by Racial and Ethnic Group......................55

Rural-Urban Disparities in Care by Racial and Ethnic Group: All Patient Experience Measures............56

Patient Experience ................................................................................................................................. 58

Rural-Urban Disparities in Care by Racial and Ethnic Group: All Clinical Care Measures.......................72

Clinical Care: Prevention and Screening................................................................................................. 75

Clinical Care: Respiratory Conditions.....................................................................................................78

Clinical Care: Cardiovascular Conditions................................................................................................81

Clinical Care: Diabetes............................................................................................................................85

Clinical Care: Musculoskeletal Conditions..............................................................................................92

Clinical Care: Behavioral Health .............................................................................................................94

Clinical Care: Medication Management and Care Coordination..........................................................102

Clinical Care: Overuse/Appropriateness ..............................................................................................107

Clinical Care: Access/Availability of Care..............................................................................................114

Section III: Racial and Ethnic Disparities in Health Care in Medicare Within Urban and Rural Areas......115

Racial and Ethnic Disparities in Care Within Urban and Rural Areas: All Patient Experience 

Measures, Medicare Advantage ..........................................................................................................116

Racial and Ethnic Disparities in Care Within Urban and Rural Areas: All Patient Experience 

Measures, Fee-for-Service ...................................................................................................................118

Patient Experience ...............................................................................................................................120
iv

Racial and Ethnic Disparities in Care Within Urban and Rural Areas: All Clinical Care Measures........135

Clinical Care: Prevention and Screening...............................................................................................139

Clinical Care: Respiratory Conditions...................................................................................................142

Clinical Care: Cardiovascular Conditions..............................................................................................148

Clinical Care: Diabetes..........................................................................................................................153

Clinical Care: Musculoskeletal Conditions............................................................................................161

Clinical Care: Behavioral Health ...........................................................................................................164

Clinical Care: Medication Management and Care Coordination..........................................................178

Clinical Care: Overuse/Appropriateness ..............................................................................................187

Clinical Care: Access/Availability of Care..............................................................................................197

Appendix: Data Sources and Methods.....................................................................................................199
Executive Summary 
vi

Introduction

This report presents summary information on the quality of health care received by Medicare 

beneficiaries nationwide. It uses annual health care data collected in 2019 and references care received 

since the 2018 data collection. The report highlights (a) rural-urban1 differences in health care 

experiences and clinical care, (b) how rural-urban differences vary by race and ethnicity, and (c) how 

racial and ethnic differences vary between rural and urban areas. 

The report is based on an analysis of two sources of information. The first source is the Medicare 

Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, which is conducted 

annually by the Centers for Medicare & Medicaid Services (CMS) and focuses on health care experiences 

(e.g., ease of getting needed care, how well providers communicate, and getting needed prescription 

drugs) of Medicare beneficiaries across the nation. The second source of information is the Healthcare 

Effectiveness Data and Information Set (HEDIS®). HEDIS is composed of information collected from 

medical records and administrative data on the technical quality of care that Medicare beneficiaries 

receive for a variety of medical issues, including diabetes, cardiovascular disease, and chronic lung 

disease. Whereas Medicare CAHPS data are available for beneficiaries enrolled in Medicare fee-forservice (FFS) and managed care (Medicare Advantage [MA]) plans, HEDIS data are available only for 

beneficiaries enrolled in MA plans.

Rural-Urban Disparities in Health Care in Medicare

With just one exception, both FFS and MA beneficiaries living in rural areas reported health care 

experiences that were similar to the experiences reported by FFS and MA beneficiaries living in urban 

areas (see Figure 1). The exception pertained to annual flu vaccination rates, which were higher for 

urban than for rural FFS and MA beneficiaries. Rural-urban disparities in clinical care were more 

common: compared with MA beneficiaries living in urban areas, MA beneficiaries living in rural areas 

had poorer results on 14 of 39 clinical quality measures, similar results on 23 measures, and better 

results on just two measures.2 The largest differences were for three clinical care measures with 

substantial deficits among rural residents, namely (a) avoiding potentially harmful drug-disease 

interactions in elderly patients with dementia (an 11-percentage-point deficit), (b) initiation of alcohol 

and other drug treatment (a 10-percentage-point deficit), and (c) controlling high blood pressure among 

patients with diabetes (a 10-percentage-point deficit).

Rural-Urban Disparities in Health Care in Medicare by Racial and Ethnic Group

The overall pattern of rural and urban residents reporting similar experiences with care generally held 

across racial and ethnic groups (American Indian or Alaska Native [AI/AN], Asian or Pacific Islander [API], 

Black, Hispanic, and White) and coverage types (Medicare FFS and MA). One notable exception involved 

1 Beneficiaries were classified as living in a rural or urban area based on the zip code of their mailing address and 

the corresponding Census Bureau core-based statistical area (CBSA). CBSAs consist of the county or counties 

associated with at least one core urban area plus adjacent counties having a high degree of social and economic 

integration with the core. Metropolitan statistical areas contain a core urban area with a population of 50,000 or 

more. Micropolitan statistical areas contain a core urban area with a population of at least 10,000 but less than 

50,000. For this report, any beneficiary residing within a metropolitan statistical area was classified as an urban 

resident; any beneficiary living in a micropolitan statistical area or outside of a CBSA was classified as a rural 

resident.

2 Here, “similar” is used to characterize differences that are not statistically significant, fall below a magnitude 

threshold, or both, as described in the appendix. “Worse” and “better” are used to characterize differences that 

are statistically significant and exceed a magnitude threshold.
vii

Hispanic beneficiaries enrolled in MA. In that group, rural residents reported better experiences with 

getting appointments and care quickly and getting needed prescription drugs than urban residents 

reported (see Figure 2).

While the pattern of generally worse results for clinical care in rural than urban areas held for all racial 

and ethnic groups,3 the pattern was more pronounced for Hispanic beneficiaries than for other groups 

(see Figure 3). Among API, Black, and White beneficiaries, rural beneficiaries had worse results on about 

a quarter to a third of clinical care measures and better results on less than 5 percent of clinical care 

measures. In contrast, among Hispanic beneficiaries, rural residents had worse results on 54 percent of 

clinical measures and better results on 13 percent of clinical care measures.

Racial and Ethnic Disparities in Health Care in Medicare Within Urban and Rural Areas

Patterns of racial and ethnic differences (compared with White beneficiaries) in patient experience were 

similar in urban and rural areas for API and Black beneficiaries but not for AI/AN and Hispanic 

beneficiaries. Disparities in patient experience for AI/AN beneficiaries versus White beneficiaries were 

more common in rural than in urban areas, regardless of coverage type (see Figures 4 and 5). Rural 

Hispanic beneficiaries typically reported experiences with care that were similar to the experiences 

reported by rural White beneficiaries, regardless of coverage type. Urban Hispanic MA beneficiaries 

typically reported experiences with care that were similar to the experiences reported by urban White 

MA beneficiaries, whereas urban Hispanic FFS beneficiaries often reported experiences with care that 

were worse than the experiences reported by urban White FFS beneficiaries. Regardless of coverage 

type and geography, API beneficiaries typically reported experiences with care that were worse than or 

similar to the experiences reported by White beneficiaries. Regardless of coverage type and geography, 

Black beneficiaries typically reported experiences with care that were similar to the experiences 

reported by White beneficiaries.

Patterns of racial and ethnic differences (compared with White beneficiaries) in clinical care were similar 

in urban versus rural areas for API and Black beneficiaries but not for Hispanic beneficiaries (see Figure 

6). Regardless of geography, API beneficiaries had worse results than White beneficiaries on 10 percent 

or less of the clinical care measures and better results on 18–25 percent of the clinical care measures. 

Regardless of geography, Black beneficiaries had worse results than White beneficiaries on about 40 

percent of the clinical care measures and better results on about 5–8 percent of the clinical care 

measures. In urban areas, Hispanic beneficiaries had worse results than White beneficiaries on 28 

percent of the clinical care measures and better results on 15 percent of the clinical care measures. In 

rural areas, Hispanic beneficiaries had worse results than White beneficiaries on 46 percent of the 

clinical care measures and better results on 31 percent of the clinical care measures.

3 For reporting clinical care (HEDIS) data stratified by race and ethnicity, racial and ethnic group membership is 

estimated using a methodology that combines information from CMS administrative data, surname, and 

residential location. Estimates of membership in the AI/AN group are less accurate than for other racial and ethnic 

groups; thus, this report does not show scores for AI/AN beneficiaries on the clinical care measures.
viii

Conclusion

This analysis of national rural-urban differences in the quality of health care received by Medicare 

beneficiaries in 2019 found that rural residents reported experiences with care that were similar to the 

experiences reported by urban residents but often had worse results for clinical care than urban 

residents (deficits on several clinical care measures exceeded 10 percentage points). Future research is 

needed to understand whether this pattern reflects poorer dissemination of clinical practice guidelines 

to rural areas, poorer translation of those guidelines into clinical practice, difficulty accessing care in 

rural areas, or some other cause. The difference between rural and urban residents in quality of clinical 

care received was most pronounced among Hispanic beneficiaries.

This analysis also revealed notable geographic variation in AI/AN-White disparities in patient experience. 

Specifically, whereas urban AI/AN beneficiaries typically reported experiences with care that were 

similar to the experiences of care reported by urban White beneficiaries, rural AI/AN beneficiaries 

typically reported experiences with care that were worse than the experiences reported by rural White 

beneficiaries. There was also notable geographic variation in Hispanic-White disparities in clinical care. 

Specifically, whereas Hispanic beneficiaries generally had worse results than White beneficiaries, the 

difference between these groups was evident far more often in rural areas than in urban areas.

Overall, these results suggest that quality improvement efforts should focus on improving clinical care 

for all rural residents and should put special emphasis on addressing the care experiences of rural AI/AN

beneficiaries and the clinical care needs of rural Hispanic beneficiaries.
ix

Figure 1. Rural-Urban Disparities in Care:

All Patient Experience and Clinical Care Measures

Number of patient experience measures and clinical care measures for which rural residents had

results that were worse than, similar to, or better than results for urban residents in 2019

SOURCES: The bar on the left summarizes patient experience data from all MA beneficiaries nationwide 

who participated in the 2019 Medicare CAHPS survey. The bar in the middle summarizes patient 

experience data from all FFS beneficiaries nationwide who participated in the 2019 Medicare CAHPS 

survey. The bar on the right summarizes clinical quality (HEDIS) data collected in 2019 from MA plans 

nationwide. Clinical quality data are not available for Medicare FFS beneficiaries.
x 

Figure 2. Rural-Urban Disparities in Care by Racial and Ethnic Group: 

All Patient Experience Measures

Number of patient experience measures for which rural AI/AN, API, Black, Hispanic, and White 

beneficiaries reported experiences that were worse than, similar to, or better than the experiences 

reported by urban AI/AN, API, Black, Hispanic, and White beneficiaries in 2019

SOURCE: This chart summarizes data from all FFS Medicare and MA beneficiaries nationwide 

who participated in the 2019 Medicare CAHPS survey. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups 

such as Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were 

classified as Hispanic regardless of races selected.

† There were not enough data from AI/AN beneficiaries enrolled in FFS to make a rural-urban 

comparison on two patient experience measures.

‡ There were not enough data from rural API beneficiaries enrolled in FFS to make rural-urban 

comparisons on two patient experience measures.
xi

Figure 3. Rural-Urban Disparities in Care by Racial and Ethnic Group: 

All Clinical Care Measures

Number of clinical care measures for which rural Asian and Pacific Islander (API), Black, Hispanic, 

and White MA beneficiaries had results that were worse than, similar to, or better than results for

urban API, Black, Hispanic, and White MA beneficiaries in 2019

SOURCE: This chart summarizes clinical quality (HEDIS) data collected in 2019 from MA plans nationwide. 

Clinical quality data are not available for Medicare FFS beneficiaries.

NOTES: API = Asian or Pacific Islander. For reporting clinical care (HEDIS) data stratified by race and 

ethnicity, racial and ethnic group membership is estimated using a methodology that combines 

information from CMS administrative data, surname, and residential location. Estimates of membership in 

AI/AN group are less accurate than for other racial and ethnic groups; thus, this report does not show 

scores for AI/AN beneficiaries on the clinical care measures. Racial groups such as Black and White are 

non-Hispanic. Hispanic ethnicity includes all races. † There were only enough data from rural API beneficiaries to make rural-urban comparisons on 34 of the 

39 clinical care measures.
xii

Figure 4. Racial and Ethnic Disparities in Care Within Urban and 

Rural Areas: All Patient Experience Measures, Medicare Advantage

Number of patient experience measures for which urban and rural residents of selected 

racial and ethnic minority groups reported experiences that were worse than, similar to, or better 

than the experiences reported by White urban and rural residents in 2019 

 

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such 

as Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as 

Hispanic regardless of races selected.
xiii

Figure 5. Racial and Ethnic Disparities in Care Within Urban and 

Rural Areas: All Patient Experience Measures, Fee-for-Service

Number of patient experience measures for which urban and rural residents of selected 

racial and ethnic minority groups reported experiences that were worse than, similar to, or better 

than the experiences reported by White urban and rural residents in 2019 

 

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected.

† For two patient experience measures, there were not enough data from urban FFS AI/AN beneficiaries 

to compare their experiences to those of urban FFS White beneficiaries.

‡ For one patient experience measure, there were not enough data from rural FFS AI/AN beneficiaries 

to compare their experiences to those of rural FFS White beneficiaries. For two patient experience 

measures, there were not enough data from rural FFS API beneficiaries to compare their experiences to 

those of rural FFS White beneficiaries.

 
xiv

Figure 6. Racial and Ethnic Disparities in Care Within Urban and 

Rural Areas: All Clinical Care Measures

Number of clinical care measures for which urban and rural residents of selected 

racial and ethnic minority groups had results that were worse than, similar to, or better than results 

for White urban and rural residents in 2019 

 

SOURCE: This chart summarizes clinical quality (HEDIS) data collected in 2019 from MA plans 

nationwide. Clinical quality data are not available for Medicare FFS beneficiaries.

NOTES: API = Asian or Pacific Islander. For reporting clinical care (HEDIS) data stratified by race and 

ethnicity, racial and ethnic group membership is estimated using a methodology that combines 

information from CMS administrative data, surname, and residential location. Estimates of 

membership in AI/AN group are less accurate than for other racial and ethnic groups; thus, this 

report does not show scores for AI/AN beneficiaries on the clinical care measures. Racial groups 

such as Black and White are non-Hispanic. Hispanic ethnicity includes all races.

† There were only enough data from rural API beneficiaries to make rural-urban comparisons on 34 

of the 39 clinical care measures.

 

 
xv

Patient Experience and Clinical Care Measures Included in This Report

Patient Experience Measures Musculoskeletal Conditions

• Rheumatoid arthritis management

• Getting needed care • Osteoporosis management in women who

• Getting appointments and care quickly had a fracture

• Customer service

• Doctors who communicate well Behavioral Health

• Care coordination • Antidepressant medication management— 

• Getting needed prescription drugs acute phase treatment

• Annual flu vaccine • Antidepressant medication management— 

continuation phase treatment

Clinical Care Measures • Follow-up after hospital stay for mental

illness (within 30 days of discharge)

Prevention and Screening • Follow-up after ED visit for mental

• Adult body mass index (BMI) assessment illness (within 30 days of discharge)

• Breast cancer screening • Follow-up after ED visit for alcohol and

• Colorectal cancer screening other drug abuse or dependence (within

30 days of discharge)

Respiratory Conditions • Initiation of alcohol and other drug

• Testing to confirm chronic obstructive dependence treatment

pulmonary disease (COPD) • Engagement of alcohol and other drug

• Pharmacotherapy management of COPD

exacerbation—systemic corticosteroid

dependence treatment

• Pharmacotherapy management of COPD Medication Management and Care Coordination

exacerbation—bronchodilator • Medication reconciliation after hospital

discharge

Cardiovascular Conditions • Transitions of care—notification of

• Controlling high blood pressure inpatient admission

• Continuous beta-blocker treatment • Transitions of care—receipt of discharge

• Statin use in patients with cardiovascular information

disease • Transitions of care—patient engagement

• Medication adherence for cardiovascular after inpatient discharge

disease—statins • Follow-up after ED visit for people with

high-risk multiple chronic conditions

Diabetes

• Diabetes care—blood sugar testing Overuse/Appropriate Use

• Diabetes care—eye exam • Avoiding potentially harmful drug-disease

• Diabetes care—kidney disease monitoring interactions in elderly patients with chronic

• Diabetes care—blood pressure controlled renal failure

• Diabetes care—blood sugar controlled • Avoiding potentially harmful drug-disease

• Statin use in patients with diabetes interactions in elderly patients with 

• Medication adherence for diabetes—statins dementia
xvi

Patient Experience and Clinical Care Measures Included in This Report

(continued)

Clinical Care Measures

Overuse/Appropriate Use

• Avoiding potentially harmful drug-disease

interactions in elderly patients with a history

of falls

• Avoiding use of high-risk medications in the

elderly

• Avoiding use of opioids at high dosage

• Avoiding use of opioids from multiple 

prescribers

• Avoiding use of opioids from multiple

pharmacies

Access/Availability of Care

• Older adults’ access to preventive/

ambulatory services
xvii

Abbreviations Used in This Report

AI/AN American Indian or Alaska Native

AMI acute myocardial infarction

AOD alcohol or other drug

API Asian or Pacific Islander

ASCVD atherosclerotic cardiovascular disease

BMI body mass index

CAHPS Consumer Assessment of Healthcare Providers and Systems

CBSA core-based statistical area

COPD chronic obstructive pulmonary disease

DMARD disease-modifying antirheumatic drug

ED emergency department

FFS fee-for-service

MA Medicare Advantage

NSAID nonsteroidal anti-inflammatory drug

PDP prescription drug plan
Overview, Methods, and 

Summary of Results 
2 

Overview

This report presents summary information on the quality of health care received by Medicare 

beneficiaries nationwide. It uses annual health care data collected in 2019 and references care received 

since the 2018 data collection. Previous versions of this report presented information on the quality of 

health care received by Medicare beneficiaries nationwide based on data collected in 2017 and 2018. 

Two types of quality of care data are included: (1) measures of patient experience, which describe how 

well the care patients receive meets their needs for such things as timely appointments, respectful care, 

clear communication, and access to information; and (2) measures of clinical care, which describe the 

extent to which patients receive appropriate screening and treatment for specific health conditions. 

Patient experience data are presented for beneficiaries enrolled in Medicare fee-for-service (FFS) as well 

as those enrolled in managed care (Medicare Advantage [MA]) plans; clinical data are presented only for 

beneficiaries enrolled in MA plans.

The Institute of Medicine (now the National Academy of Medicine) has identified the equitable delivery 

of care as a hallmark of quality (Institute of Medicine, 2001). Assessing equity of care delivery requires 

making comparisons of quality by patient characteristics such as urban or rural residence, race, and 

ethnicity. Prior studies have found higher rates of chronic illness and poorer overall health in rural 

communities compared with urban populations. One possible source of these differences in morbidity is 

disparate experiences with health care and differences in access to high-quality care between rural and 

urban areas (Meit et al., 2014). There is also evidence that the health care disadvantages faced by those 

living in rural areas are sometimes greater for racial and ethnic minorities compared with those who are 

non-Hispanic White, and that racial and ethnic disparities are sometimes greater in rural than in urban 

areas (James et al., 2017; Probst et al., 2004). This may be because living in a rural area exacerbates

exposure to unequal social conditions that foster disparities in health care (Caldwell et al., 2016). 

Given these prior findings, three sets of comparisons are presented in this report. In the first set, quality 

of care for rural residents is compared with quality of care for urban residents. In the second, quality of 

care for rural residents is compared with quality of care for urban residents of the same race or 

ethnicity. In the third, quality of care for racial and ethnic minority beneficiaries is compared with quality 

of care for White beneficiaries separately within rural and urban areas. The focus of this report is on 

differences in quality of care that exist at the national level. Interested readers can find information 

about health care quality for specific Medicare plans at https://www.medicare.gov/plan-compare. 

Data Sources

In all, this report provides data regarding seven patient experience measures and 39 clinical care 

measures. The set of patient experience measures presented in this report is the same as the set 

reported on in the 2018 and 2019 reports (reporting 2017 and 2018 data, respectively). To minimize 

redundancy among the clinical care measures, five measures that were included in the 2019 report are 

excluded from this report. The five excluded measures are Follow-up After Hospital Stay for Mental 

Illness (within seven days of discharge), Follow-up After ED Visit for Mental Illness (within seven days of 

discharge), Follow-up After ED Visit for Alcohol and Other Drug Abuse or Dependence (within seven days 

of discharge), Transitions of Care: Medication Reconciliation After Hospital Discharge, and Avoiding Use 

of Opioids from Multiple Prescribers and Pharmacies.

4

4 This report presents data on (a) versions of each of the first three measures that pertain to follow-up received 

within 30 days of discharge, (b) a separate but similar measure on medication reconciliation after hospital 

discharge, and (c) a pair of measures that pertain separately to avoiding use of opioids from multiple prescribers 

and avoiding use of opioids from multiple pharmacies.
3 

Patient experience data were collected from a national survey of Medicare beneficiaries, known as the 

Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey. This survey is 

administered each year to both Medicare FFS and MA beneficiaries. The data in this report are from the 

2019 Medicare CAHPS survey. Examples of patient experience measures include how easy it is to get 

needed care, how well doctors communicate with beneficiaries, and how easy it is for beneficiaries to 

get information from their drug plans about prescription drug coverage and cost.

Clinical care data were gathered through medical records and insurance claims for hospitalizations, 

medical office visits, and procedures. These data, which are collected each year from MA plans 

nationwide, are part of the Healthcare Effectiveness Data and Information Set (HEDIS®). HEDIS data are 

not available for FFS beneficiaries. In this report, clinical care measures are grouped into nine categories: 

prevention and screening, respiratory conditions, cardiovascular conditions, diabetes, musculoskeletal 

conditions, behavioral health, medication management and care coordination, overuse/ 

appropriateness, and access/availability of care. Although the annual flu vaccination measure is a HEDIS 

measure, it is collected via the Medicare CAHPS survey and so is included with the patient experience 

measures in this report. The HEDIS data reported here were collected in 2019. Whereas all patient 

experience measures are applicable to beneficiaries aged 18 years and older, certain HEDIS measures 

apply to beneficiaries in a more limited age range, as noted throughout the report.

Beneficiaries were classified as living in a rural or urban area based on the zip code of their mailing 

address and the corresponding Census Bureau core-based statistical area (CBSA). CBSAs consist of the 

county or counties or equivalent entities associated with at least one core urban area plus adjacent 

counties having a high degree of social and economic integration with the core as measured through 

commuting ties with the counties that make up the core. Metropolitan statistical areas contain a core 

urban area with a population of 50,000 or more. Micropolitan statistical areas contain a core urban area 

with a population of at least 10,000 but less than 50,000. For this report, any beneficiary residing within 

a metropolitan statistical area was classified as an urban resident; any beneficiary living in a 

micropolitan statistical area or outside of a CBSA was classified as a rural resident. By this definition, 

15.6 percent (approximately 2.8 million) of MA beneficiaries and 21.5 percent (approximately 7.0 

million) of FFS beneficiaries were rural residents in 2019. Of all Medicare beneficiaries residing in rural 

areas in 2019, 28.4 percent were enrolled in MA; of beneficiaries residing in urban areas, 36.9 percent 

were enrolled in MA.

The 2019 CAHPS survey asked beneficiaries to report their race and ethnicity. Survey responses were 

used to classify respondents into one of seven mutually exclusive categories: Hispanic, multiracial, 

American Indian/Alaska Native (AI/AN), Asian/Pacific Islander (API), Black, White, or unknown. The 

appendix provides detail on the survey questions and classification scheme. Unknown cases were 

dropped from the analysis. The multiracial group was included in the analysis, but estimates for this 

group are not presented in this report. HEDIS data, unlike CAHPS data, do not contain the patient’s selfreported race and ethnicity. Therefore, we imputed race and ethnicity for the HEDIS data using a 

methodology that combines information from administrative data, surname, and residential location 

(Haas et al., 2019). This methodology is recommended for estimating racial and ethnic disparities for 

Black, Hispanic, API, and White beneficiaries, but not for AI/AN or multiracial beneficiaries. Thus, this 

report does not show scores for AI/AN beneficiaries on the clinical care measures.

Reportability of Information

Sample size criteria were used to determine whether a score on a measure was reportable for a 

particular group. Scores based on 400 or more observations were considered sufficiently precise for 

reporting as is. Scores based on more than 99 but fewer than 400 observations were considered low in 

precision and were flagged as such. In this report, flagged scores—which should be regarded as 
4 

tentative information—are shown unbolded with a superscript symbol appended; the symbol links to a 

note at the bottom of the chart that cautions about the precision of the score. Scores based on 99 or 

fewer observations are suppressed (i.e., not reported). When a score is suppressed for a particular 

group, a note appears at the bottom of the relevant chart saying that there were not enough data from 

that group to make a rural-urban or racial and ethnic comparison on the measure. 

Rural-Urban Disparities in Health Care in Medicare

Section I of the report begins with a stacked bar chart showing the number of patient experience 

measures (out of seven) and the number of clinical care measures (out of 39) for which rural residents 

had results that were worse than, similar to, or better than results for urban residents.5 In this chart, 

information on patient experience is presented separately for Medicare FFS and MA beneficiaries. 

Following the stacked bar chart are separate, unstacked bar charts for each patient experience and 

clinical care measure. Charts for patient experience measures show the average score for rural and 

urban FFS and MA beneficiaries on a 0–100 scale. The average score represents the percentage of the 

best possible score for a given group for that measure. For example, consider a measure for which the 

best possible score is 4 and the worst possible score is 1. If a given group’s score on that measure is 3.5, 

then that group’s score on a 0–100 scale is ([3.5 − 1] / [4 − 1]) × 100 = 83.3. Charts for clinical care 

measures show the percentage of rural and urban MA beneficiaries whose care met the standard called 

for by the specific measure (e.g., receiving a clinically indicated test or treatment).

Rural-Urban Disparities in Health Care in Medicare by Racial and Ethnic Group

Section II of the report shows how rural-urban gaps in health care vary from one racial or ethnic group 

to another. Section II begins with a set of stacked bar charts that show, separately for American Indian 

or Alaska Native (AI/AN), Asian or Pacific Islander (API), Black, Hispanic, and White Medicare FFS and MA 

beneficiaries, the number of patient experience measures for which rural residents reported 

experiences of care that were worse than, similar to, or better than the experiences reported by urban 

residents. There was enough information from Black, Hispanic, and White FFS and MA beneficiaries, and 

from AI/AN and API MA beneficiaries, to compare rural and urban residents on all seven measures. 

Rural-urban comparisons among AI/AN and API FFS beneficiaries were possible for five measures.

Following these stacked bar charts are separate, unstacked bar charts for each patient experience 

measure. These charts show, separately for AI/AN, API, Black, Hispanic, and White FFS and MA

beneficiaries, the average score for rural and urban residents on a 0–100 scale. After the patient 

experience measures, Section II presents a set of stacked bar charts that show, separately for API, Black, 

Hispanic, and White MA beneficiaries, the number of clinical care measures for which rural residents 

had results that were worse than, similar to, or better than results for urban residents. There was 

enough information from Black, Hispanic, and White beneficiaries to compare rural and urban residents 

on all 39 clinical care measures. Rural-urban comparisons among API beneficiaries were possible for 34 

clinical care measures. Following the stacked bar charts are separate, unstacked bar charts for each 

clinical care measure that show, separately for API (where available), Black, Hispanic, and White MA 

beneficiaries, the percentage of rural and urban residents whose care met the standard called for by the 

measure.

Racial and Ethnic Disparities in Health Care in Medicare Within Urban and Rural Areas

5 Here, “similar” is used to characterize differences that are not statistically significant, fall below a magnitude 

threshold, or both, as described in the appendix. “Worse” and “better” are used to characterize differences that 

are statistically significant and exceed a magnitude threshold. 
5 

Section III of the report begins with four stacked bar charts that show, separately for rural and urban 

Medicare FFS and MA beneficiaries, the number of patient experience measures for which members of 

each racial and ethnic minority group reported experiences of care that were worse than, similar to, or 

better than the experiences reported by White beneficiaries. There was enough information from rural 

and urban MA and FFS beneficiaries to compare Black and Hispanic beneficiaries to White beneficiaries 

on all seven measures. There was also enough information from rural and urban AI/AN MA beneficiaries, 

rural and urban API MA beneficiaries, and urban API FFS beneficiaries to compare them to White

beneficiaries on all seven measures. There was enough information from rural API FFS beneficiaries to 

compare them to White beneficiaries on six measures, and there was enough information from urban 

AI/AN FFS beneficiaries and rural API FFS beneficiaries to compare them to White beneficiaries on five 

measures. Following these stacked bar charts are separate, unstacked bar charts for each patient 

experience measure. These charts show, separately for rural and urban MA and FFS beneficiaries, the 

average score for each racial and ethnic group on a 0–100 scale. After the patient experience measures, 

Section III presents a pair of stacked bar charts that show, separately for rural and urban MA 

beneficiaries, the number of clinical care measures for which members of each racial and ethnic

minority group had results that were worse than, similar to, or better than results for White

beneficiaries. There was enough information from rural and urban Black and Hispanic beneficiaries and 

from urban API beneficiaries to compare them to White beneficiaries on all 39 measures. Rural APIWhite comparisons were possible for 34 measures. Following these stacked bar charts are separate, 

unstacked bar charts for each clinical care measure that show, separately for rural and urban MA 

beneficiaries, the percentage of beneficiaries in each racial and ethnic group whose care met the 

standard called for by the specific measure.

For detailed information on data sources and analytic methods, see the appendix.

Summary of Results and Conclusions

Rural residents, regardless of race or ethnicity, often had worse clinical care results than urban 

residents. Although patient experience scores are adjusted for a broad set of case-mix variables (see the 

appendix), clinical care scores are not. It is therefore possible that the differences observed between 

rural and urban residents in the quality of clinical care are attributable to factors that are not accounted 

for in the analysis. Future research is needed to understand whether this pattern reflects poorer 

dissemination of clinical practice guidelines to rural areas, poorer translation of those guidelines into 

clinical practice, or some other cause. Findings from that research would be useful for informing efforts 

to address these disparities. The difference between rural and urban residents in clinical care results was 

most pronounced among Hispanic beneficiaries. Future research is therefore also needed to determine 

why rural Hispanic beneficiaries are at especially high risk for poor clinical care. Rural-urban differences 

in experiences of care were much more limited, both overall and for each racial and ethnic group.

This analysis also revealed notable geographic variation in AI/AN-White disparities in patient experience. 

Specifically, whereas urban AI/AN beneficiaries typically reported experiences with care that were 

similar to the experiences of care reported by urban White beneficiaries, rural AI/AN beneficiaries 

typically reported experiences with care that were worse than the experiences reported by rural White 

beneficiaries. There was also notable geographic variation in Hispanic-White disparities in clinical care. 

Specifically, whereas Hispanic beneficiaries generally had worse clinical care results than White 

beneficiaries, the difference between these groups was evident far more often in rural areas than in 

urban areas. These results suggest the need to give special attention to addressing the care experiences 

of rural AI/AN beneficiaries and the clinical care needs of rural Hispanic beneficiaries.
Section I: 

Rural-Urban Disparities in 

Health Care in Medicare 
7 

Rural-Urban Disparities in Care:

All Patient Experience and Clinical Care Measures

Number of patient experience measures and clinical care measures for which rural residents had 

results that were worse than, similar to, or better than results for urban residents in 2019

SOURCES: The bar on the left summarizes patient experience data from all MA beneficiaries nationwide 

who participated in the 2019 Medicare CAHPS survey. The bar in the middle summarizes patient experience 

data from all FFS beneficiaries nationwide who participated in the 2019 Medicare CAHPS survey. The bar on 

the right summarizes clinical quality (HEDIS) data collected in 2019 from MA plans nationwide. Clinical 

quality data not are available for Medicare FFS beneficiaries.

The relative difference between rural and urban is used to assess disparities.

• Better = Rural residents had better results than urban residents. Differences are statistically significant 

(p < 0.05), are equal to or larger than 3 points† on a 0–100 scale, and favor rural residents.

• Similar = Rural and urban residents had similar results. Differences are less than 3 points on a 0–100 

scale (differences greater than 3 points were always statistically significant). Differences may be 

statistically significant.

• Worse = Rural residents had worse results than urban residents. Differences are statistically significant, 

are equal to or larger than 3 points on a 0–100 scale, and favor urban residents.

† A difference that is considered to be of moderate magnitude (Paddison et al., 2013). 
8 

Rural residents had worse results than urban residents

• Annual flu vaccination

• Testing to confirm COPD

• Pharmacotherapy management of COPD exacerbation—use of systemic corticosteroid

• Pharmacotherapy management of COPD exacerbation—use of bronchodilators

• Diabetes care—blood pressure controlled

• Statin use in patients with diabetes

• Osteoporosis management in women who had a fracture

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Follow-up after emergency department visit for mental illness (within 30 days of discharge)

• Initiation of alcohol and other drug dependence treatment

• Follow-up after emergency department visit for people with high-risk multiple chronic conditions

• Avoiding potentially harmful drug-disease interactions in elderly patients with chronic renal failure

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

Rural residents had better results than urban residents

• Follow-up after hospital stay for mental illness (within 30 days of discharge)

• Avoiding use of opioids from multiple prescribers
9 

Patient Experience

Getting Needed Care

Percentage of the best possible score (on a 0–100 scale) earned on how easy it is for patients to get 

needed care,† by geography within coverage type, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

Disparities

o Among both MA and FFS beneficiaries, rural and urban residents reported similar 

experiences with getting needed care.

_____________________________________

† This includes how often in the last six months patients got appointments with specialists as soon as they needed 

them and how easy it was to get needed care, tests, or treatment.

 

 

 
10

Getting Appointments and Care Quickly

Percentage of the best possible score (on a 0–100 scale) earned on how quickly

patients get appointments and care,† by geography within coverage type, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

Disparities

o Among both MA and FFS beneficiaries, rural and urban residents reported similar 

experiences with getting appointments and care quickly.

_____________________________________

† This includes how often in the last six months patients got care that was needed right away, as well as how easy it 

was to get appointments for checkups and routine care.

 

 

 

 
11

Customer Service

Percentage of the best possible score (on a 0–100 scale) earned on three aspects of customer 

service,

† by geography within coverage type, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

Disparities

o Among both MA and FFS beneficiaries, rural and urban residents reported similar

experiences with customer service.

_____________________________________

† This includes how often in the last six months health plan customer service staff provided the information or the 

help that beneficiaries needed, how often beneficiaries were treated with courtesy and respect, and how often 

forms from the health plan were easy to fill out.

 

 

 
12

Doctors Who Communicate Well

Percentage of the best possible score (on a 0–100 scale) earned on how well doctors

communicate with patients,† by geography within coverage type, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

Disparities

o Among MA beneficiaries, rural and urban residents reported similar experiences with 

doctor communication.

o Among FFS beneficiaries, rural residents reported better‡ experiences with doctor 

communication than urban residents reported. The difference between rural and urban 

residents was less than 3 points on a 0–100 scale.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† This includes how often in the last six months doctors explained things in a way that was easy to understand, 

listened carefully, showed respect for what patients had to say, and spent time with patients.

‡ Unlike on pages 7–8, we use the terms “better” or “worse” to describe all statistically significant differences on 

individual patient experience measures. We note in the “Disparities” section for each of these measures where 

differences are greater or less than 3 points.

 

 

 

 
13

Care Coordination

Percentage of the best possible score (on a 0–100 scale) earned on how well patient care is 

coordinated,† by geography within coverage type, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

Disparities

o Among both MA and FFS beneficiaries, rural and urban residents reported similar 

experiences with care coordination.

_____________________________________

† This includes how often in the last six months doctors had medical records and other information about patients’ 

care at patients’ scheduled appointments and how quickly patients received their test results.

 

 

 

 
14

Getting Needed Prescription Drugs

Percentage of the best possible score (on a 0–100 scale) earned on how easy it is for beneficiaries to 

get the prescription drugs they need using their plans,† by geography within coverage type, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

Disparities

o Among both MA and FFS beneficiaries, rural and urban residents reported similar 

experiences with getting needed prescription drugs.

_____________________________________

† This includes how often in the last six months it was easy to use the plan to get prescribed medications and how 

easy it was to fill prescriptions at a pharmacy or by mail.

 

 

 
15

Annual Flu Vaccine

Percentage of Medicare enrollees who got a vaccine (flu shot),

by geography within coverage type, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

Disparities

o Among both MA and FFS beneficiaries, rural residents were less likely than urban residents

to have received the flu vaccine. In each case, the difference between rural and urban 

residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

 
16

Clinical Care: Prevention and Screening

Adult BMI Assessment

Percentage of MA enrollees aged 18 to 74 years who had an outpatient visit whose body mass 

index (BMI) was documented in the past two years, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for FFS Medicare beneficiaries.

Disparities

o Rural residents were less likely than urban residents to have had their BMIs documented. 

The difference between rural and urban residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

 
17

Breast Cancer Screening

Percentage of MA enrollees (women) aged 50 to 74 years who had appropriate screening for breast 

cancer, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural women were less likely than urban women to have been appropriately screened for 

breast cancer. The difference between rural and urban women was less than 3 percentage 

points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

 
18

Colorectal Cancer Screening

Percentage of MA enrollees aged 50 to 75 years who had appropriate screening for

colorectal cancer, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents were about as likely as urban residents to have been appropriately 

screened for colorectal cancer.
19

Clinical Care: Respiratory Conditions

Testing to Confirm COPD

Percentage of MA enrollees aged 40 years and older with a new diagnosis of chronic obstructive 

pulmonary disease (COPD) or newly active COPD who received appropriate spirometry testing to 

confirm the diagnosis, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with a new diagnosis of COPD or newly active COPD were less likely than 

urban residents with a new diagnosis of COPD or newly active COPD to have received a 

spirometry test to confirm the diagnosis. The difference between rural and urban residents 

was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
20

Pharmacotherapy Management of COPD Exacerbation— 

Systemic Corticosteroid

Percentage of MA enrollees aged 40 years and older who had an acute inpatient discharge or 

emergency department encounter for COPD exacerbation in the past year who were dispensed a 

systemic corticosteroid within 14 days of the event, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who experienced a COPD exacerbation were less likely than urban residents 

who experienced a COPD exacerbation to have been dispensed a systemic corticosteroid 

within 14 days of the event. The difference between rural and urban residents was greater 

than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
21

Pharmacotherapy Management of COPD Exacerbation—Bronchodilator

Percentage of MA enrollees aged 40 years and older who had an acute inpatient discharge or 

emergency department encounter for COPD exacerbation in the past year who were dispensed a 

bronchodilator within 30 days of experiencing the event, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who experienced a COPD exacerbation were less likely than urban residents 

who experienced a COPD exacerbation to have been dispensed a bronchodilator within 30 

days of the event. The difference between rural and urban residents was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
22

Clinical Care: Cardiovascular Conditions

Controlling High Blood Pressure

Percentage of MA enrollees aged 18 to 85 years who had a diagnosis of hypertension whose blood 

pressure was adequately controlled† during the past year, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who had a diagnosis of hypertension were about as likely as urban residents 

who had a diagnosis of hypertension to have had their blood pressure adequately 

controlled. 

_____________________________________

† Less than 140/90 for enrollees 18 to 59 years of age and for enrollees 60 to 85 years of age with a diagnosis of 

diabetes, or less than 150/90 for members 60 to 85 years of age without a diagnosis of diabetes.
23

Continuous Beta-Blocker Treatment

Percentage of MA enrollees aged 18 years and older who were hospitalized and discharged alive 

with a diagnosis of acute myocardial infarction (AMI) who received persistent beta-blocker 

treatment for six months after discharge, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were hospitalized for a heart attack were about as likely as urban 

residents who were hospitalized for a heart attack to have received persistent beta-blocker 

treatment.

 
24

Statin Use in Patients with Cardiovascular Disease

Percentage of male MA enrollees aged 21 to 75 years and female MA enrollees aged 40 to 75 years 

with clinical atherosclerotic cardiovascular disease (ASCVD) who received statin therapy, 

by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with ASCVD were less likely than urban residents with ASCVD to have 

received statin therapy. The difference between rural and urban residents was less than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
25

Medication Adherence for Cardiovascular Disease—Statins

Percentage of male MA enrollees aged 21 to 75 years and female MA enrollees aged 40 to 75 years 

with clinical atherosclerotic cardiovascular disease (ASCVD) who were dispensed a statin 

medication during the measurement year who remained on the medication for at least 80 percent 

of the treatment period, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with ASCVD were less likely than urban residents with ASCVD to have had 

proper statin medication adherence. The difference between rural and urban residents was 

less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.
26

Clinical Care: Diabetes

Diabetes Care—Blood Sugar Testing

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) who had one or 

more HbA1c tests in the past year, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with diabetes were less likely than urban residents with diabetes to have 

had their blood sugar tested at least once in the past year. The difference between rural 

and urban residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
27

Diabetes Care—Eye Exam

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) who had an eye 

exam (retinal) in the past year, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with diabetes were less likely than urban residents with diabetes to have 

had an eye exam in the past year. The difference between rural and urban residents was 

less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
28

Diabetes Care—Kidney Disease Monitoring

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) who had medical 

attention for nephropathy in the past year, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with diabetes were less likely than urban residents with diabetes to have 

had medical attention for nephropathy in the past year. The difference between rural and 

urban residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
29

Diabetes Care—Blood Pressure Controlled

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) whose most 

recent blood pressure was less than 140/90, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with diabetes were less likely than urban residents with diabetes to have 

their blood pressure under control. The difference between rural and urban residents was 

greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
30

Diabetes Care—Blood Sugar Controlled

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) whose most 

recent HbA1c level was 9 percent or less, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with diabetes were less likely than urban residents with diabetes to have 

their blood sugar levels under control. The difference between rural and urban residents 

was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
31

Statin Use in Patients with Diabetes

Percentage of MA enrollees aged 40 to 75 years with diabetes (type 1 and type 2)† who received 

statin therapy, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with diabetes were less likely than urban residents with diabetes to have 

received statin therapy. The difference between rural and urban residents was greater than 

3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Excludes those who also have clinical atherosclerotic cardiovascular disease. 

 
32

Medication Adherence for Diabetes—Statins

Percentage of MA enrollees aged 40 to 75 years with diabetes (type 1 and type 2)† who were 

dispensed a statin medication during the measurement year who remained on the medication for 

at least 80 percent of the treatment period, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with diabetes were less likely than urban residents with diabetes to have 

had proper statin medication adherence. The difference between rural and urban residents

was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Excludes those who also have clinical atherosclerotic cardiovascular disease.
33

Clinical Care: Musculoskeletal Conditions

Rheumatoid Arthritis Management

Percentage of MA enrollees aged 18 years and older who were diagnosed with rheumatoid arthritis 

during the past year who were dispensed at least one ambulatory prescription for a diseasemodifying antirheumatic drug (DMARD), by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were diagnosed with rheumatoid arthritis were less likely than urban

residents who were diagnosed with rheumatoid arthritis to have been dispensed at least 

one DMARD. The difference between rural and urban residents was less than 3 percentage 

points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
34

Osteoporosis Management in Women Who Had a Fracture

Percentage of MA enrollees (women) aged 67 to 85 years who suffered a fracture who had either a 

bone mineral density test or a prescription for a drug to treat osteoporosis in the six months after 

the fracture, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural women who suffered a fracture were less likely than urban women who suffered a 

fracture to have had either a bone mineral density test or a prescription for a drug to treat 

osteoporosis. The difference between rural and urban residents was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
35

Clinical Care: Behavioral Health

Antidepressant Medication Management—Acute Phase Treatment

Percentage of MA enrollees aged 18 years and older with a new diagnosis of major depression who 

were newly treated with antidepressant medication and remained on the medication for at least 84 

days, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were diagnosed with a new episode of major depression were less 

likely than urban residents who were diagnosed with a new episode of major depression to 

have been newly treated with antidepressant medication and to have remained on the

medication for at least 84 days. The difference between rural and urban residents was 

greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
36

Antidepressant Medication Management—Continuation Phase Treatment

Percentage of MA enrollees aged 18 years and older with a new diagnosis of major depression who 

were newly treated with antidepressant medication and remained on the medication for at least 

180 days, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were diagnosed with a new episode of major depression were less 

likely than urban residents who were diagnosed with a new episode of major depression to 

have been newly treated with antidepressant medication and to have remained on the

medication for at least 180 days. The difference between rural and urban residents was 

greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
37

Follow-up After Hospital Stay for Mental Illness

(within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who were hospitalized for treatment of 

selected mental health disorders who had an outpatient visit, an intensive outpatient encounter, or 

partial hospitalization with a mental health practitioner within 30 days of discharge,

by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were hospitalized for a mental health disorder were more likely than 

urban residents who were hospitalized for a mental health disorder to have had a followup visit with a mental health practitioner within 30 days of discharge. The difference 

between rural and urban residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Although the lower-bound age cutoff for this HEDIS measure is six years old, the data used in this report are 

limited to adults.

 
38

Follow-up After Emergency Department (ED) Visit for Mental Illness

(within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who had an ED visit for selected mental health 

disorders who had an outpatient visit, an intensive outpatient encounter, or partial hospitalization 

with a mental health practitioner within 30 days of the ED visit, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who had an ED visit for a mental health disorder were less likely than urban 

residents who had an ED visit for a mental health disorder to have had a follow-up visit 

with a mental health practitioner within 30 days of the ED visit. The difference between 

rural and urban residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Although the lower-bound age cutoff for this HEDIS measure is six years old, the data used in this report are 

limited to adults.
39

Follow-up After Emergency Department (ED) Visit for Alcohol and Other Drug

(AOD) Abuse or Dependence (within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who had an ED visit for AOD abuse or 

dependence who had a follow-up visit for AOD abuse or dependence within 30 days of the ED visit, 

by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who had an ED visit for AOD abuse or dependence were less likely than 

urban residents who had an ED visit for AOD abuse or dependence to have had a follow-up 

visit for AOD abuse or dependence within 30 days of being discharged. The difference 

between rural and urban residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.
40

Initiation of Alcohol and Other Drug Dependence (AOD) Treatment

Percentage of MA enrollees aged 18 years and older† with a new episode of AOD dependence who 

initiated‡ treatment within 14 days of the diagnosis, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with a new episode of AOD dependence were less likely than urban 

residents with a new episode of AOD dependence to have initiated treatment within 14 

days of the diagnosis. The difference between rural and urban residents was greater than 3

percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.

‡ Initiation may occur through an inpatient AOD admission, outpatient visit, intensive outpatient encounter, or 

partial hospitalization.
41

Engagement of Alcohol and Other Drug Dependence (AOD) Treatment

Percentage of MA enrollees aged 18 years and older† with a new episode of AOD dependence who 

initiated treatment who had two or more AOD services or medication-assisted treatments within 30 

days of the initiation visit, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Overall performance on this measure was lower than on any other measure: Less than 4 

percent of those who initiated treatment for AOD dependence received two or more AOD 

services or medication-assisted treatments within 30 days of their initial visit for treatment. 

Rural residents with a new episode of AOD dependence who initiated treatment were less 

likely than urban residents with a new episode of AOD dependence who initiated 

treatment to have had two or more AOD services or medication-assisted treatments within 

30 days of their initial visit for treatment. The difference between rural and urban residents 

was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.
42

Clinical Care: Medication Management and Care Coordination

Medication Reconciliation After Hospital Discharge

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

who had their medications reconciled within 30 days, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were discharged from an inpatient facility were less likely than urban 

residents who were discharged from an inpatient facility to have had their medications 

reconciled within 30 days. The difference between rural and urban residents was less than 

3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
43

Transitions of Care—Notification of Inpatient Admission

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

whose primary or ongoing care providers were notified of the inpatient admission on the day of or 

the day following admission, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o The primary or ongoing care providers of rural residents who were discharged from an 

inpatient facility were less likely than the primary or ongoing care providers of urban 

residents who were discharged from an inpatient facility to have been notified of the 

inpatient admission on the day of or the day following admission. The difference between 

these groups was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
44

Transitions of Care—Receipt of Discharge Information

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

who received discharge information on the day of or the day following discharge, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were discharged from an inpatient facility were less likely than urban 

residents who were discharged from an inpatient facility to have received discharge 

information on the day of or the day following discharge. The difference between rural and 

urban residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.
45

Transitions of Care—Patient Engagement After Inpatient Discharge

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

for whom patient engagement (office visit, home visit, telehealth) was provided within 30 days of 

discharge, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents who were discharged from an inpatient facility were more likely than urban 

residents who were discharged from an inpatient facility to have had an office visit, to have 

had a home visit, or to have received telehealth services within 30 days of discharge. The 

difference between rural and urban residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
46

Follow-up After Emergency Department (ED) Visit for People with High-Risk 

Multiple Chronic Conditions

Percentage of MA enrollees aged 18 years and older with multiple high-risk chronic conditions† who 

received follow-up care within seven days of an ED visit, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural residents with multiple high-risk chronic conditions were less likely than urban 

residents with multiple high-risk chronic conditions to have received follow-up care within 

seven days of an ED visit. The difference between rural and urban residents was greater 

than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Conditions include COPD and asthma, Alzheimer’s disease and related disorders, chronic kidney disease, 

depression, heart failure, acute myocardial infarction, atrial fibrillation, and stroke and transient ischemic attack.
47

Clinical Care: Overuse/Appropriateness

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with Chronic Renal Failure

Percentage of MA enrollees aged 65 years and older with chronic renal failure who were not 

dispensed a prescription for a potentially harmful medication,† by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of potentially harmful medication was avoided less often for elderly rural residents 

with chronic renal failure than for elderly urban residents with chronic renal failure. The 

difference between elderly rural and urban residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† This includes cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) and nonaspirin NSAIDs.

90.8

86.0

Urban Rural

Percentage

* (-)
48

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with Dementia

Percentage of MA enrollees aged 65 years and older with dementia who were not dispensed a 

prescription for a potentially harmful medication,† by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of potentially harmful medication was avoided less often for elderly rural residents 

with dementia than for elderly urban residents with dementia. The difference between 

elderly rural and urban residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† This includes antiemetics, antipsychotics, benzodiazepines, tricyclic antidepressants, H2 receptor antagonists, 

nonbenzodiazepine hypnotics, and anticholinergic agents.
49

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with a History of Falls

Percentage of MA enrollees aged 65 years and older with a history of falls who were not dispensed 

a prescription for a potentially harmful medication,† by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of potentially harmful medication was avoided less often for elderly rural residents 

with a history of falls than for elderly urban residents with a history of falls. The difference 

between elderly rural and urban residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† This includes anticonvulsants, nonbenzodiazepine hypnotics, selective serotonin reuptake inhibitors, antiemetics, 

antipsychotics, benzodiazepines, and tricyclic antidepressants.
50

Avoiding Use of High-Risk Medications in the Elderly

Percentage of MA enrollees aged 65 years and older who were not prescribed a high-risk 

medication, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of high-risk medication was avoided less often for elderly rural residents than for 

elderly urban residents. The difference between elderly rural and urban residents was less 

than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
51

Avoiding Use of Opioids at High Dosage

Percentage of MA enrollees aged 18 years and older who were not prescribed opioids at a high 

dosage† for more than 14 days, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of opioids at a high dosage for more than 14 days was avoided more often for rural 

residents than for urban residents. The difference between rural and urban residents was 

less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† Average morphine equivalent dose > 120 mg. 
52

Avoiding Use of Opioids from Multiple Prescribers

Percentage of MA enrollees aged 18 years and older who did not receive prescriptions for opioids 

from four or more prescribers in the past year, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of opioids from multiple prescribers was avoided more often for rural residents than 

for urban residents. The difference between rural and urban residents was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
53

Avoiding Use of Opioids from Multiple Pharmacies

Percentage of MA enrollees aged 18 years and older who did not receive prescriptions for opioids 

from four or more pharmacies in the past year, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of opioids from multiple pharmacies was avoided less often for rural residents than for 

urban residents. The difference between rural and urban residents was less than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
54

Clinical Care: Access/Availability of Care

Older Adults’ Access to Preventive/Ambulatory Services

Percentage of MA enrollees aged 65 years and older who had an ambulatory or preventive care visit

in the past year, by geography, 2019

SOURCE: Clinical quality data collected in 2019 from MA plans nationwide.

NOTE: Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Rural older adults were more likely than urban older adults to have had an ambulatory or 

preventive care visit. The difference between rural and urban older adults was less than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents (p < 0.05).

For differences that are statistically significant, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 
Section II: 

Rural-Urban Disparities in Health Care in 

Medicare by Racial and Ethnic Group 
56

Rural-Urban Disparities in Care by Racial and Ethnic Group: 

All Patient Experience Measures

Number of patient experience measures for which rural AI/AN, API, Black, Hispanic, and White 

beneficiaries reported experiences that were worse than, similar to, or better than the experiences 

reported by urban AI/AN, API, Black, Hispanic, and White beneficiaries in 2019

SOURCE: This chart summarizes data from all FFS Medicare and MA beneficiaries nationwide 

who participated in the 2019 Medicare CAHPS survey. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups 

such as Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were 

classified as Hispanic regardless of races selected.

† There were not enough data from AI/AN beneficiaries enrolled in FFS to make a rural-urban 

comparison on two patient experience measures.

‡ There were not enough data from rural API beneficiaries enrolled in FFS to make rural-urban 

comparisons on two patient experience measures.

 
57

Rural AI/AN MA beneficiaries had worse results than urban AI/AN MA beneficiaries

• Care coordination

Rural Black MA beneficiaries had worse results than urban Black MA beneficiaries

• Annual flu vaccine

Rural Black MA beneficiaries had better results than urban Black MA beneficiaries

• Customer service

Rural Hispanic MA beneficiaries had better results than urban Hispanic MA beneficiaries

• Getting appointments and care quickly

• Getting needed prescription drugs

Rural API FFS beneficiaries had worse results than urban API FFS beneficiaries

• Annual flu vaccine

Rural Hispanic FFS beneficiaries had worse results than urban Hispanic FFS beneficiaries

• Annual flu vaccine

Rural White FFS beneficiaries had worse results than urban White FFS beneficiaries

• Annual flu vaccine
58

Patient Experience

Getting Needed Care

Percentage of the best possible score (on a 0–100 scale) earned on how easy it is for patients to get 

needed care,

† by geography within racial and ethnic group, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as Black 

and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic regardless of 

races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o In both MA and FFS, AI/AN beneficiaries residing in rural areas reported experiences getting 

needed care that were similar to the experiences reported by AI/AN beneficiaries residing in 

urban areas.

o In both MA and FFS, API beneficiaries residing in rural areas reported experiences getting 

needed care that were similar to the experiences reported by API beneficiaries residing in 

urban areas.

o In both MA and FFS, Black beneficiaries residing in rural areas reported experiences getting 

needed care that were similar to the experiences reported by Black beneficiaries residing in 

urban areas.

o In both MA and FFS, Hispanic beneficiaries residing in rural areas reported experiences 

getting needed care that were similar to the experiences reported by Hispanic beneficiaries 

residing in urban areas.

 

 

 

 

 

  

 

 
59

o In both MA and FFS, White beneficiaries residing in rural areas reported experiences getting 

needed care that were similar to the experiences reported by White beneficiaries residing in 

urban areas. 

_____________________________________

† This includes how often in the last six months patients got appointments with specialists as soon as they needed 

them and how easy it was to get needed care, tests, or treatment.
60

Getting Appointments and Care Quickly

Percentage of the best possible score (on a 0–100 scale) earned on how quickly

patients get appointments and care,

† by geography within racial and ethnic group, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as Black 

and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic regardless of 

races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o In both MA and FFS, AI/AN beneficiaries residing in rural areas reported experiences getting 

appointments and care quickly that were similar to the experiences reported by AI/AN 

beneficiaries residing in urban areas.

o In both MA and FFS, API beneficiaries residing in rural areas reported experiences getting 

appointments and care quickly that were similar to the experiences reported by API

beneficiaries residing in urban areas.

o In both MA and FFS, Black beneficiaries residing in rural areas reported experiences getting 

appointments and care quickly that were similar to the experiences reported by Black

beneficiaries residing in urban areas.

o Hispanic MA beneficiaries residing in rural areas reported better‡ experiences getting 

appointments and care quickly than Hispanic MA beneficiaries residing in urban areas. The 

difference between rural and urban Hispanic MA beneficiaries was greater than 3 points on a 

0–100 scale. Hispanic FFS beneficiaries residing in rural areas reported experiences getting 

appointments and care quickly that were similar to the experiences reported by Hispanic FFS 

beneficiaries residing in urban areas.

 

 

 

 

 

 

 
61

o In both MA and FFS, White beneficiaries residing in rural areas reported experiences getting 

appointments and care quickly that were similar to the experiences reported by White

beneficiaries residing in urban areas.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group and coverage type 

(p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity and 

coverage type, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† This includes how often in the last six months patients got care that was needed right away, as well as how easy it 

was to get appointments for checkups and routine care.

‡ Unlike on pages 56–57, we use the terms “better” or “worse” to describe all statistically significant differences on 

individual patient experience measures. We note in the “Disparities” section for each of these measures where 

differences are greater or less than 3 points.
62

Customer Service

Percentage of the best possible score (on a 0–100 scale) earned on three aspects of customer service,

†

by geography within racial and ethnic group, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as Black 

and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic regardless of 

races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from AI/AN FFS beneficiaries or API FFS beneficiaries to make rural-urban 

comparisons on this measure.

Disparities

o AI/AN MA beneficiaries residing in rural areas reported experiences with customer service 

that were similar to the experiences reported by AI/AN MA beneficiaries residing in urban 

areas.

o API MA beneficiaries residing in rural areas reported experiences with customer service that 

were similar to the experiences reported by API MA beneficiaries residing in urban areas.

o Black MA beneficiaries residing in rural areas reported better experiences with customer 

service than Black MA beneficiaries residing in urban areas. The difference between rural and 

urban Black MA beneficiaries was greater than 3 points on a 0–100 scale. Black FFS 

beneficiaries residing in rural areas reported experiences with customer service that were 

similar to the experiences reported by Black FFS beneficiaries residing in urban areas.

o In both MA and FFS, Hispanic beneficiaries residing in rural areas reported experiences with 

customer service that were similar to the experiences reported by Hispanic beneficiaries 

residing in urban areas.

 

 

 

 

 

 

 

 
63

o In both MA and FFS, White beneficiaries residing in rural areas reported experiences with 

customer service that were similar to the experiences reported by White beneficiaries 

residing in urban areas.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group and coverage type 

(p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity and 

coverage type, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

† This includes how often in the last six months health plan customer service staff provided the information or help 

that beneficiaries needed, how often beneficiaries were treated with courtesy and respect, and how often forms 

from the health plan were easy to fill out.
64

Doctors Who Communicate Well

Percentage of the best possible score (on a 0–100 scale) earned on how well doctors communicate 

with patients,

† by geography within racial and ethnic group, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as Black 

and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic regardless of 

races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. 

Disparities

o In both MA and FFS, AI/AN beneficiaries residing in rural areas reported experiences with 

doctor communication that were similar to the experiences reported by AI/AN beneficiaries 

residing in urban areas.

o In both MA and FFS, API beneficiaries residing in rural areas reported experiences with doctor 

communication that were similar to the experiences reported by API beneficiaries residing in 

urban areas.

o Black MA beneficiaries residing in rural areas reported experiences with doctor communication 

that were similar to the experiences reported by Black MA beneficiaries residing in urban areas.

Black FFS beneficiaries residing in rural areas reported better experiences with doctor 

communication than Black FFS beneficiaries residing in urban areas. The difference between 

rural and urban Black FFS beneficiaries was less than 3 points on a 0–100 scale.

o In both MA and FFS, Hispanic beneficiaries residing in rural areas reported experiences with 

doctor communication that were similar to the experiences reported by Hispanic beneficiaries 

residing in urban areas.

 

 

 

 

 

 

 

 
65

o In both MA and FFS, White beneficiaries residing in rural areas reported experiences with 

doctor communication that were similar to the experiences reported by White beneficiaries 

residing in urban areas.

_____________________________________

† This includes how often in the last six months doctors explained things in a way that was easy to understand, 

listened carefully, showed respect for what patients had to say, and spent time with patients.
66

Care Coordination

Percentage of the best possible score (on a 0–100 scale) earned on how well patient care was 

coordinated,

† by geography within racial and ethnic group, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as Black 

and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic regardless of 

races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o AI/AN MA beneficiaries residing in rural areas reported worse experiences with care 

coordination than AI/AN MA beneficiaries residing in urban areas. The difference between 

rural and urban AI/AN MA beneficiaries was greater than 3 points on a 0–100 scale. AI/AN FFS 

beneficiaries residing in rural areas reported experiences with care coordination that were 

similar to the experiences reported by AI/AN FFS beneficiaries residing in urban areas.

o In both MA and FFS, API beneficiaries residing in rural areas reported experiences with care 

coordination that were similar to the experiences reported by API beneficiaries residing in 

urban areas.

o In both MA and FFS, Black beneficiaries residing in rural areas reported experiences with care 

coordination that were similar to the experiences reported by Black beneficiaries residing in 

urban areas.

o In both MA and FFS, Hispanic beneficiaries residing in rural areas reported experiences with 

care coordination that were similar to the experiences reported by Black beneficiaries 

residing in urban areas.

 

 

 

 

 

 

 
67

o In both MA and FFS, White beneficiaries residing in rural areas reported experiences with 

care coordination that were similar to the experiences reported by White beneficiaries 

residing in urban areas. 

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group and coverage type 

(p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity and 

coverage type, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† This includes how often in the last six months doctors had medical records and other information about patients’ 

care at patients’ scheduled appointments and how quickly patients received their test results.
68

Getting Needed Prescription Drugs

Percentage of the best possible score (on a 0–100 scale) earned on how easy it is for beneficiaries to get 

the prescription drugs they need using their plans,

† by geography within racial and ethnic group, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as Black 

and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic regardless of 

races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from AI/AN FFS beneficiaries or API FFS beneficiaries to make rural-urban 

comparisons on this measure.

Disparities

o AI/AN MA beneficiaries residing in rural areas reported experiences getting needed 

prescription drugs that were similar to the experiences reported by AI/AN MA beneficiaries 

residing in urban areas.

o API MA beneficiaries residing in rural areas reported experiences getting needed prescription 

drugs that were similar to the experiences reported by API MA beneficiaries residing in urban 

areas. 

o In both MA and FFS, Black beneficiaries residing in rural areas reported experiences getting 

needed prescription drugs that were similar to the experiences reported by Black 

beneficiaries residing in urban areas.

o Hispanic MA beneficiaries residing in rural areas reported better experiences getting needed 

prescription drugs than Hispanic beneficiaries residing in urban areas. The difference between 

rural and urban Hispanic MA beneficiaries was greater than 3 points on a 0–100 scale. 

Hispanic FFS beneficiaries residing in rural areas reported experiences getting needed 

 

 

 

 

 

 
69

prescription drugs that were similar to the experiences reported by Hispanic FFS beneficiaries 

residing in urban areas.

o In both MA and FFS, White beneficiaries residing in rural areas reported experiences getting 

needed prescription drugs that were similar to the experiences reported by White

beneficiaries residing in urban areas.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group and coverage type 

(p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity and 

coverage type, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† This includes how often in the last six months it was easy to use the plan to get prescribed medications and how 

easy it was to fill prescriptions at a pharmacy or by mail.
70

Annual Flu Vaccine

Percentage of Medicare enrollees who got a vaccine (flu shot), by geography

within racial and ethnic group, 2019

SOURCE: Data from the Medicare CAHPS survey, 2019. 

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as Black 

and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic regardless of 

races selected.

† This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o In both MA and FFS, AI/AN beneficiaries residing in rural areas were about as likely as AI/AN 

beneficiaries residing in urban areas to have received the flu vaccine.

o API MA beneficiaries residing in rural areas were about as likely as API MA beneficiaries 

residing in urban areas to have received the flu vaccine. API FFS beneficiaries residing in rural 

areas were less likely than API FFS beneficiaries residing in urban areas to have received the 

flu vaccine. The difference between rural and urban API FFS beneficiaries was greater than 3 

percentage points.

o Black MA beneficiaries residing in rural areas were less likely than Black MA beneficiaries 

residing in urban areas to have received the flu vaccine. The difference between rural and 

urban Black MA beneficiaries was greater than 3 percentage points. Black FFS beneficiaries 

residing in rural areas were about as likely as Black FFS beneficiaries residing in urban areas to

have received the flu vaccine. 

o Hispanic MA beneficiaries residing in rural areas were about as likely as Hispanic MA 

beneficiaries residing in urban areas to have received the flu vaccine. Hispanic FFS 

beneficiaries residing in rural areas were less likely than Hispanic FFS beneficiaries residing in 

 

 

 

 

 
71

urban areas to have received the flu vaccine. The difference between rural and urban 

Hispanic FFS beneficiaries was greater than 3 percentage points.

o In both MA and FFS, White beneficiaries residing in rural areas were less likely than White 

beneficiaries residing in urban areas to have received the flu vaccine. In MA, the difference 

between rural and urban White beneficiaries was less than 3 percentage points. In FFS, the 

difference between rural and urban White beneficiaries was greater than 3 percentage 

points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group and coverage type 

(p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity and 

coverage type, the following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.
72

Rural-Urban Disparities in Care by Racial and Ethnic Group: 

All Clinical Care Measures

Number of clinical care measures for which rural Asian and Pacific Islander (API), Black, Hispanic, 

and White MA beneficiaries had results that were worse than, similar to, or better than results for

urban API, Black, Hispanic, and White MA beneficiaries in 2019

SOURCE: This chart summarizes clinical quality (HEDIS) data collected in 2019 from Medicare health plans 

nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † There were only enough data from rural API beneficiaries to make rural-urban comparisons on 34 of the 

39 clinical care measures.

Within each racial or ethnic group, the relative difference between rural and urban residents is used to assess 

disparities.

• Better = Rural residents had better results than urban residents. Differences are statistically significant 

(p < 0.05), are equal to or larger than 3 points‡ on a 0–100 scale, and favor rural residents.

• Similar = Rural and urban residents had similar results. Differences are less than 3 points on a 0–100 

scale and/or not statistically significant.

• Worse = Rural residents had worse results than urban residents. Differences are statistically significant, 

are equal to or larger than 3 points on a 0–100 scale, and favor urban residents.

‡ A difference that is considered to be of moderate magnitude (Paddison et al., 2013).

 

 
73

Rural API beneficiaries had worse results than urban API beneficiaries

• Breast cancer screening

• Pharmacotherapy management of COPD exacerbation—use of bronchodilators

• Controlling high blood pressure

• Diabetes care—blood pressure controlled

• Statin use in patients with diabetes

• Medication adherence for diabetes—statins

• Antidepressant medication management—acute phase treatment

• Transitions of care—notification of inpatient admission

• Transitions of care—receipt of discharge information

• Follow-up after emergency department visit for people with high-risk multiple chronic conditions

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

Rural Black beneficiaries had worse results than urban Black beneficiaries 

• Testing to confirm COPD

• Pharmacotherapy management of COPD exacerbation—use of systemic corticosteroid

• Pharmacotherapy management of COPD exacerbation—use of bronchodilators

• Diabetes care—blood pressure controlled

• Osteoporosis management in women who had a fracture

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Follow-up after emergency department visit for alcohol and other drug abuse or dependence (within 30 

days of discharge)

• Initiation of alcohol and other drug dependence treatment

• Transitions of care—notification of inpatient admission

• Transitions of care—receipt of discharge information

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

• Avoiding use of high-risk medication in the elderly

Rural Black beneficiaries had better results than urban Black beneficiaries 

• Avoiding use of opioids from multiple prescribers

• Avoiding use of opioids from multiple pharmacies
74

Rural Hispanic beneficiaries had worse results than urban Hispanic beneficiaries 

• Testing to confirm COPD

• Pharmacotherapy management of COPD exacerbation—use of systemic corticosteroid

• Pharmacotherapy management of COPD exacerbation—use of bronchodilators

• Continuous beta-blocker treatment after a heart attack

• Medication adherence for cardiovascular disease—statins

• Diabetes care—blood sugar testing

• Diabetes care—blood pressure controlled

• Statin use in patients with diabetes

• Medication adherence for diabetes—statins

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Initiation of alcohol and other drug dependence treatment

• Medication reconciliation after hospital discharge

• Transitions of care—notification of inpatient admission

• Transitions of care—receipt of discharge information

• Transitions of care—patient engagement after inpatient discharge

• Follow-up after emergency department visit for people with high-risk multiple chronic conditions

• Avoiding potentially harmful drug-disease interactions in elderly patients with chronic renal failure

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

• Avoiding use of opioids from multiple pharmacies

Rural Hispanic beneficiaries had better results than urban Hispanic beneficiaries 

• Colorectal cancer screening

• Controlling high blood pressure

• Osteoporosis management in women who had a fracture

• Follow-up after hospital stay for mental illness (within 30 days of discharge)

• Avoiding use of opioids from multiple prescribers

Rural White beneficiaries had worse results than urban White beneficiaries 

• Breast cancer screening

• Testing to confirm COPD

• Diabetes care—eye exam

• Diabetes care—blood pressure controlled

• Statin use in patients with diabetes

• Osteoporosis management in women who had a fracture

• Follow-up after emergency department visit for mental illness (within 30 days of discharge)

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

Rural White beneficiaries had better results than urban White beneficiaries 

• Initiation of alcohol and other drug dependence treatment

• Avoiding use of opioids from multiple prescribers
75

Clinical Care: Prevention and Screening

Adult BMI Assessment

Percentage of MA enrollees aged 18 to 74 years who had an outpatient visit whose body mass index 

(BMI) was documented in the past two years, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, and Hispanic beneficiaries, rural residents were about as likely as urban 

residents to have had their BMIs documented.

o Among White beneficiaries, rural residents were less likely than urban residents to have 

had their BMIs documented. The difference between rural and urban White residents was 

less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 
76

Breast Cancer Screening

Percentage of MA enrollees (women) aged 50 to 74 years who had appropriate screening for breast 

cancer, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, and White women, rural residents were less likely than urban residents 

to have been appropriately screened for breast cancer. The difference between rural and 

urban API women was greater than 3 percentage points, as was the difference between 

rural and urban White women. The difference between rural and urban Black women was 

less than 3 percentage points.

o Among Hispanic women, rural residents were more likely than urban residents to have 

been appropriately screened for breast cancer. The difference between rural and urban 

Hispanic women was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 

 
77

Colorectal Cancer Screening

Percentage of MA enrollees aged 50 to 75 years who had appropriate screening for

colorectal cancer, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API and Black beneficiaries, rural residents were about as likely as urban residents 

to have been appropriately screened for colorectal cancer.

o Among Hispanic beneficiaries, rural residents were more likely than urban residents to 

have been appropriately screened for colorectal cancer. The difference between rural and 

urban Hispanic beneficiaries was greater than 3 percentage points.

o Among White beneficiaries, rural residents were less likely than urban residents to have 

been appropriately screened for colorectal cancer. The difference between rural and 

urban White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 
78

Clinical Care: Respiratory Conditions

Testing to Confirm COPD

Percentage of MA enrollees aged 40 years and older with a new diagnosis of chronic obstructive 

pulmonary disease (COPD) or newly active COPD who received appropriate spirometry testing to 

confirm the diagnosis, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API beneficiaries, rural residents with a new diagnosis of COPD or newly active 

COPD were about as likely as urban residents with a new diagnosis of COPD or newly active 

COPD to have received a spirometry test to confirm the diagnosis. 

o Among Black, Hispanic, and White beneficiaries, rural residents with a new diagnosis of 

COPD or newly active COPD were less likely than urban residents with a new diagnosis of 

COPD or newly active COPD to have received a spirometry test to confirm the diagnosis. 

For each of these racial and ethnic groups, the difference between rural and urban 

residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 
79

Clinical Care: Pharmacotherapy Management of COPD

Exacerbation—Systemic Corticosteroid

Percentage of MA enrollees aged 40 years and older who had an acute inpatient discharge or 

emergency department encounter for COPD exacerbation in the past year who were dispensed a 

systemic corticosteroid within 14 days of the event, by geography within racial and ethnic group, 

2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API beneficiaries, rural residents who experienced a COPD exacerbation were about 

as likely as urban residents who experienced a COPD exacerbation to have been dispensed 

a systemic corticosteroid within 14 days of the event.

o Among Black, Hispanic, and White beneficiaries, rural residents who experienced a COPD 

exacerbation were less likely than urban residents who experienced a COPD exacerbation 

to have been dispensed a systemic corticosteroid within 14 days of the event. The 

difference between rural and urban Black beneficiaries was greater than 3 percentage 

points, as was the difference between rural and urban Hispanic beneficiaries. The 

difference between rural and urban White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
80

Clinical Care: Pharmacotherapy Management of COPD

Exacerbation—Bronchodilator

Percentage of MA enrollees aged 40 years and older who had an acute inpatient

discharge or emergency department encounter for COPD exacerbation in the past year

who were dispensed a bronchodilator within 30 days of experiencing the event, 

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, rural residents who experienced a 

COPD exacerbation were less likely than urban residents who experienced a COPD 

exacerbation to have been dispensed a bronchodilator within 30 days of the event. For API, 

Black, and Hispanic beneficiaries, the difference between rural and urban residents was 

greater than 3 percentage points. For White beneficiaries, the difference between rural 

and urban residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
81

Clinical Care: Cardiovascular Conditions

Controlling High Blood Pressure

Percentage of MA enrollees aged 18 to 85 years who had a diagnosis of hypertension

whose blood pressure was adequately controlled† during the past year,

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API and White beneficiaries, rural residents with a diagnosis of hypertension were 

less likely than urban residents with a diagnosis of hypertension to have had their blood 

pressure adequately controlled. For API beneficiaries, the difference between rural and 

urban residents was greater than 3 percentage points. For White beneficiaries, the 

difference between rural and urban residents was less than 3 percentage points.

o Among Black beneficiaries, rural residents with a diagnosis of hypertension were about as 

likely as urban residents with a diagnosis of hypertension to have had their blood pressure 

adequately controlled.

o Among Hispanic beneficiaries, rural residents with a diagnosis of hypertension were more

likely than urban residents with a diagnosis of hypertension to have had their blood 

pressure adequately controlled. The difference between rural and urban Hispanic

beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Less than 140/90 for enrollees 18 to 59 years of age and for enrollees 60 to 85 years of age with a diagnosis of 

diabetes, or less than 150/90 for members 60 to 85 years of age without a diagnosis of diabetes.

 
82

Continuous Beta-Blocker Treatment

Percentage of MA enrollees aged 18 years and older who were hospitalized and discharged alive 

with a diagnosis of acute myocardial infarction (AMI) who received persistent beta-blocker 

treatment for six months after discharge, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † There were not enough data from API beneficiaries to make a rural-urban comparison on this measure.

Disparities

o Among Black and White beneficiaries, rural residents who were hospitalized for a heart 

attack were about as likely as urban residents who were hospitalized for a heart attack to 

have received persistent beta-blocker treatment. 

o Among Hispanic beneficiaries, rural residents who were hospitalized for a heart attack 

were less likely than urban residents who were hospitalized for a heart attack to have

received persistent beta-blocker treatment. The difference between rural and urban 

Hispanic beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 
83

Statin Use in Patients with Cardiovascular Disease

Percentage of male MA enrollees aged 21 to 75 years and female MA enrollees aged 40 to 75 years 

with clinical atherosclerotic cardiovascular disease (ASCVD) who received statin therapy, 

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Hispanic, and White beneficiaries, rural residents with ASCVD were less likely 

than urban residents with ASCVD to have received statin therapy. For each of these racial 

and ethnic groups, the difference between rural and urban residents was less than 3 

percentage points.

o Rural Black beneficiaries with ASCVD were about as likely as urban Black beneficiaries with 

ASCVD to have received statin therapy.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
84

Medication Adherence for Cardiovascular Disease—Statins

Percentage of male MA enrollees aged 21 to 75 years and female MA enrollees aged 40 to 75 years 

with clinical atherosclerotic cardiovascular disease (ASCVD) who were dispensed a statin 

medication during the measurement year who remained on the medication for at least 80 percent 

of the treatment period, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API and Black beneficiaries, rural residents with ASCVD were about as likely as 

urban residents with ASCVD to have had proper statin medication adherence.

o Among Hispanic and White beneficiaries, rural residents with ASCVD were less likely than 

urban residents with ASCVD to have had proper statin medication adherence. The 

difference between rural and urban Hispanic beneficiaries was greater than 3 percentage 

points. The difference between rural and urban White beneficiaries was less than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 
85

Clinical Care: Diabetes

Diabetes Care—Blood Sugar Testing

Percentage of Medicare Advantage enrollees aged 18 to 75 years with diabetes (type 1 and type 2) 

who had one or more HbA1c tests in the past year, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API beneficiaries, rural residents with diabetes were about as likely as urban 

residents with diabetes to have had their blood sugar tested at least once in the past year.

o Among Black, Hispanic, and White beneficiaries, rural residents with diabetes were less 

likely than urban residents with diabetes to have had their blood sugar tested at least once 

in the past year. The difference between rural and urban Black beneficiaries was less than 3 

percentage points, as was the difference between rural and urban White beneficiaries. The 

difference between rural and urban Hispanic beneficiaries was greater than 3 percentage 

points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
86

Diabetes Care—Eye Exam

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) who had an eye 

exam (retinal) in the past year, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, and Hispanic beneficiaries, rural residents with diabetes were about as

likely as urban residents with diabetes to have had an eye exam in the past year.

o Among White beneficiaries, rural residents with diabetes were less likely than urban 

residents with diabetes to have had an eye exam in the past year. The difference between 

rural and urban White beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 
87

Diabetes Care—Kidney Disease Monitoring

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) who had medical 

attention for nephropathy in the past year, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API and Black beneficiaries, rural residents with diabetes were about as likely as 

urban residents with diabetes to have had medical attention for nephropathy in the past 

year.

o Among Hispanic beneficiaries, rural residents with diabetes were more likely than urban 

residents with diabetes to have had medical attention for nephropathy in the past year. 

The difference between rural and urban Hispanic beneficiaries was less than 3 percentage 

points.

o Among White beneficiaries, rural residents with diabetes were less likely than urban 

residents with diabetes to have had medical attention for nephropathy in the past year. 

The difference between rural and urban White beneficiaries was less than 3 percentage 

points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
88

Diabetes Care—Blood Pressure Controlled

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) whose most 

recent blood pressure was less than 140/90, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, rural residents with diabetes were less 

likely than urban residents with diabetes to have their blood pressure under control. For 

each of these racial and ethnic groups, the difference between rural and urban residents 

was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
89

Diabetes Care—Blood Sugar Controlled

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) whose most 

recent HbA1c level was 9 percent or less, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, and Hispanic beneficiaries, rural residents with diabetes were about as

likely as urban residents with diabetes to have their blood sugar levels under control.

o Among White beneficiaries, rural residents with diabetes were less likely than urban 

residents with diabetes to have their blood sugar levels under control. The difference 

between rural and urban White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
90

Statin Use in Patients with Diabetes

Percentage of MA enrollees aged 40 to 75 years with diabetes (type 1 and type 2)† who received 

statin therapy, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, rural residents with diabetes were less 

likely than urban residents with diabetes to have received statin therapy. The difference 

between rural and urban API beneficiaries was greater than 3 percentage points, as were 

the differences between rural and urban Hispanic beneficiaries and rural and urban White

beneficiaries. The difference between rural and urban Black beneficiaries was less than 3 

percentage points. 

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Excludes those who also have clinical atherosclerotic cardiovascular disease.

 

 
91

Medication Adherence for Diabetes—Statins

Percentage of MA enrollees aged 40 to 75 years with diabetes (type 1 and type 2)† who were 

dispensed a statin medication during the measurement year who remained on the medication for 

at least 80 percent of the treatment period, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, rural residents with diabetes were less 

likely than urban residents with diabetes to have had proper statin medication adherence. 

The difference between rural and urban API beneficiaries was greater than 3 percentage 

points, as was the difference between rural and urban Hispanic beneficiaries. The 

difference between rural and urban Black beneficiaries was less than 3 percentage points, 

as was the difference between rural and urban White beneficiaries.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Excludes those who also have clinical atherosclerotic cardiovascular disease.

 

 
92

Clinical Care: Musculoskeletal Conditions

Rheumatoid Arthritis Management

Percentage of MA enrollees aged 18 years and older who were diagnosed with rheumatoid arthritis 

during the past year who were dispensed at least one ambulatory prescription for a diseasemodifying antirheumatic drug (DMARD), by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API and Hispanic beneficiaries, rural residents diagnosed with rheumatoid arthritis 

were about as likely as urban residents diagnosed with rheumatoid arthritis to have been 

dispensed at least one DMARD.

o Among Black and White beneficiaries, rural residents diagnosed with rheumatoid arthritis 

were less likely than urban residents diagnosed with rheumatoid arthritis to have been 

dispensed at least one DMARD. In each case, the difference between rural and urban 

residents was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
93

Osteoporosis Management in Women Who Had a Fracture

Percentage of MA enrollees (women) aged 67 to 85 years who suffered a fracture who had either a 

bone mineral density test or a prescription for a drug to treat osteoporosis in the six months after 

the fracture, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low. ‡ There were not enough data from API beneficiaries to make a rural-urban comparison on this measure.

Disparities

o Among Black and White women, rural residents who suffered a fracture were less likely 

than urban residents who suffered a fracture to have had either a bone mineral density 

test or a prescription for a drug to treat osteoporosis. The difference between rural and 

urban Black women was greater than 3 percentage points, as was the difference between 

rural and urban White women.

o Rural Hispanic women who suffered a fracture were more likely than urban Hispanic 

women who suffered a fracture to have had either a bone mineral density test or a 

prescription for a drug to treat osteoporosis. The difference between rural and urban 

Hispanic women was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 
94

Clinical Care: Behavioral Health

Antidepressant Medication Management—Acute Phase Treatment

Percentage of MA enrollees aged 18 years and older with a new diagnosis of major depression who 

were newly treated with antidepressant medication and remained on the medication for at least 84 

days, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, rural residents who were diagnosed 

with a new episode of major depression were less likely than urban residents who were 

diagnosed with a new episode of major depression to have been newly treated with 

antidepressant medication and to have remained on the medication for at least 84 days. 

The difference between rural and urban API beneficiaries was greater than 3 percentage 

points, as were the differences between rural and urban Black beneficiaries and rural and 

urban Hispanic beneficiaries. The difference between rural and urban White beneficiaries 

was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

 

 
95

Antidepressant Medication Management—Continuation Phase Treatment

Percentage of MA enrollees aged 18 years and older with a new diagnosis of major depression who 

were newly treated with antidepressant medication and remained on the medication for at least 

180 days, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API beneficiaries, rural residents who were diagnosed with a new episode of major 

depression were about as likely as urban residents who were diagnosed with a new 

episode of major depression to have been newly treated with antidepressant medication 

and to have remained on the medication for at least 180 days.

o Among Black, Hispanic, and White beneficiaries, rural residents who were diagnosed with a 

new episode of major depression were less likely than urban residents who were diagnosed 

with a new episode of major depression to have been newly treated with antidepressant 

medication and to have remained on the medication for at least 180 days. The difference 

between rural and urban Black beneficiaries was greater than 3 percentage points, as was

the difference between rural and urban Hispanic beneficiaries. The difference between 

rural and urban White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
96

Follow-up After Hospital Stay for Mental Illness

(within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who were hospitalized for treatment of 

selected mental health disorders who had an outpatient visit, an intensive outpatient encounter, or 

partial hospitalization with a mental health practitioner within 30 days of discharge,

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from API beneficiaries to make a rural-urban comparison on this measure.

Disparities

o Among Black beneficiaries, rural residents who were hospitalized for a mental health 

disorder were about as likely as urban residents who were hospitalized for a mental health 

disorder to have had a follow-up visit with a mental health practitioner within 30 days of 

discharge.

o Among Hispanic beneficiaries, rural residents who were hospitalized for a mental health 

disorder were more likely than urban residents who were hospitalized for a mental health 

disorder to have had a follow-up visit with a mental health practitioner within 30 days of 

discharge. The difference between rural and urban Hispanic beneficiaries was greater than 

3 percentage points.

o Among White beneficiaries, rural residents who were hospitalized for a mental health 

disorder were less likely than urban residents who were hospitalized for a mental health 

disorder to have had a follow-up visit with a mental health practitioner within 30 days of 

discharge. The difference between rural and urban White beneficiaries was less than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.
97

† Although the lower-bound age cutoff for this HEDIS measure is six years old, the data used in this report are 

limited to adults.
98

Follow-up After Emergency Department (ED) Visit for Mental Illness

(within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who had an ED visit for selected

mental health disorders who had an outpatient visit, an intensive outpatient encounter,

or partial hospitalization with a mental health practitioner within 30 days of the ED visit, 

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from API beneficiaries to make a rural-urban comparison on this measure.

Disparities

o Among Black and Hispanic beneficiaries, rural residents who had an ED visit for a mental 

health disorder were about as likely as urban residents who had an ED visit for a mental 

health disorder to have had a follow-up visit with a mental health practitioner within 30 

days of the ED visit. 

o Among White beneficiaries, rural residents who had an ED visit for a mental health disorder 

were less likely than urban residents who had an ED visit for a mental health disorder to 

have had a follow-up visit with a mental health practitioner within 30 days of the ED visit. 

The difference between rural and urban White beneficiaries was greater than 3 percentage 

points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Although the lower-bound age cutoff for this HEDIS measure is six years old, the data used in this report are 

limited to adults.
99

Follow-up After Emergency Department (ED) Visit for Alcohol and Other Drug 

(AOD) Abuse or Dependence (within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who had an ED visit for AOD abuse or 

dependence who had a follow-up visit for AOD abuse or dependence within 30 days of the ED visit, 

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from API beneficiaries to make a rural-urban comparison on this measure.

Disparities

o Among Black and White beneficiaries, rural residents who had an ED visit for AOD abuse or 

dependence were less likely than urban residents who had an ED visit for AOD abuse or 

dependence to have had a follow-up visit for AOD abuse or dependence within 30 days of 

the ED visit. The difference between rural and urban Black beneficiaries was greater than 3 

percentage points. The difference between rural and urban White beneficiaries was less 

than 3 percentage points.

o Among Hispanic beneficiaries, rural residents who had an ED visit for AOD abuse or 

dependence were about as likely as urban residents who had an ED visit for AOD abuse or 

dependence to have had a follow-up visit for AOD abuse or dependence within 30 days of 

the ED visit.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.

 

 
100

Initiation of Alcohol and Other Drug Dependence (AOD) Treatment

Percentage of MA enrollees aged 18 years and older† with a new episode of

AOD dependence who initiate‡ treatment within 14 days of the diagnosis, 

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API beneficiaries, rural residents with a new episode of AOD dependence were 

about as likely as urban residents with a new episode of AOD dependence to have initiated 

treatment within 14 days of diagnosis. 

o Among Black and Hispanic beneficiaries, rural residents with a new episode of AOD 

dependence were less likely than urban residents with a new episode of AOD dependence 

to have initiated treatment within 14 days of diagnosis. In each case, the difference

between rural and urban residents was greater than 3 percentage points.

o Among White beneficiaries, rural residents with a new episode of AOD dependence were 

more likely than urban residents with a new episode of AOD dependence to have initiated 

treatment within 14 days of diagnosis. The difference between rural and urban White

beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.

‡ Initiation may occur through an inpatient AOD admission, outpatient visit, intensive outpatient encounter, or 

partial hospitalization.
101

Engagement of Alcohol and Other Drug Dependence (AOD) Treatment

Percentage of MA enrollees aged 18 years and older† with a new episode of AOD dependence who 

initiated treatment who had two or more AOD services or medication-assisted treatments within 30 

days of the initiation visit, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API beneficiaries, rural residents with a new episode of AOD dependence who 

initiated treatment were about as likely as urban residents with a new episode of AOD 

dependence who initiated treatment to have had two or more AOD services or medicationassisted treatments within 30 days of their initial visit for treatment.

o Among Black and Hispanic beneficiaries, rural residents with a new episode of AOD 

dependence who initiated treatment were less likely than urban residents with a new 

episode of AOD dependence who initiated treatment to have had two or more AOD services 

or medication-assisted treatments within 30 days of their initial visit for treatment. In each 

case, the difference between rural and urban residents was less than 3 percentage points.

o Among White beneficiaries, rural residents with a new episode of AOD dependence who 

initiated treatment were more likely than urban residents with a new episode of AOD 

dependence who initiated treatment to have had two or more AOD services or medicationassisted treatments within 30 days of their initial visit for treatment. The difference 

between rural and urban White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.

 

 
102

Clinical Care: Medication Management and Care Coordination

Medication Reconciliation After Hospital Discharge

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

who had their medications reconciled within 30 days, by geography within racial and ethnic group, 

2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, and White beneficiaries, rural residents who were discharged from an 

inpatient facility were about as likely as urban residents who were discharged from an 

inpatient facility to have had their medications reconciled within 30 days.

o Among Hispanic beneficiaries, rural residents who were discharged from an inpatient 

facility were less likely than urban residents who were discharged from an inpatient facility 

to have had their medications reconciled within 30 days. The difference between rural and 

urban Hispanic beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 

 
103

Transitions of Care—Notification of Inpatient Admission

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

whose primary or ongoing care providers were notified of the inpatient admission on the day of or 

the day following admission, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, the primary or ongoing care providers 

of rural residents who were discharged from an inpatient facility were less likely than the 

primary or ongoing care providers of urban residents who were discharged from an 

inpatient facility to have been notified of the inpatient admission on the day of or the day 

following admission. For API, Black, and Hispanic beneficiaries, the difference was greater 

than 3 percentage points. For White beneficiaries, the difference was less than 3 

percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

 

 

 
104

Transitions of Care—Receipt of Discharge Information

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

who received discharge information on the day of or the day following discharge, by geography

within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Among API, Black, and Hispanic beneficiaries, rural residents who were discharged from an 

inpatient facility were less likely than urban residents who were discharged from an 

inpatient facility to have received discharge information on the day of or the day following 

discharge. For each of these racial and ethnic groups, the difference between rural and 

urban residents was greater than 3 percentage points.

o Rural White beneficiaries who were discharged from an inpatient facility were about as

likely as urban White beneficiaries who were discharged from an inpatient facility to have 

received discharge information on the day of or the day following discharge.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
105

Transitions of Care—Patient Engagement After Inpatient Discharge

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

for whom patient engagement (office visit, home visit, telehealth) was provided within 30 days of 

discharge, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API beneficiaries, rural residents who were discharged from an inpatient facility 

were about as likely as urban residents who were discharged from an inpatient facility to 

have had an office visit, to have had a home visit, or to have received telehealth services 

within 30 days of discharge. 

o Among Black and White beneficiaries, rural residents who were discharged from an 

inpatient facility were more likely than urban residents who were discharged from an 

inpatient facility to have had an office visit, to have had a home visit, or to have received 

telehealth services within 30 days of discharge. The difference between rural and urban 

Black beneficiaries was less than 3 percentage points, as was the difference between rural 

and urban White beneficiaries.

o Rural Hispanic beneficiaries who were discharged from an inpatient facility were less likely 

than urban Hispanic beneficiaries who were discharged from an inpatient facility to have 

had an office visit, to have had a home visit, or to have received telehealth services within 

30 days of discharge. The difference between rural and urban Hispanic beneficiaries was 

greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
106

Follow-up After Emergency Department (ED) Visit for People with High-Risk 

Multiple Chronic Conditions

Percentage of MA enrollees aged 18 years and older with multiple high-risk chronic conditions† who 

received follow-up care within seven days of an ED visit, by geography within racial and ethnic 

group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, rural residents with multiple high-risk 

chronic conditions were less likely than urban residents with multiple high-risk chronic 

conditions to have received follow-up care within seven days of an ED visit. The difference 

between rural and urban API beneficiaries was greater than 3 percentage points, as was 

the difference between rural and urban Hispanic beneficiaries. The difference between 

rural and urban Black beneficiaries was less than 3 percentage points, as was the difference 

between rural and urban White beneficiaries.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Conditions include COPD and asthma, Alzheimer’s disease and related disorders, chronic kidney disease, 

depression, heart failure, acute myocardial infarction, atrial fibrillation, and stroke and transient ischemic attack.

 

 
107

Clinical Care: Overuse/Appropriateness

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with Chronic Renal Failure

Percentage of MA enrollees aged 65 years and older with chronic renal failure who were not 

dispensed a prescription for a potentially harmful medication,†

by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API beneficiaries, use of potentially harmful medication was avoided about as often 

for elderly rural residents with chronic renal failure as for elderly urban residents with 

chronic renal failure.

o Among Black, Hispanic, and White beneficiaries, use of potentially harmful medication was 

avoided less often for elderly rural residents with chronic renal failure than for elderly 

urban residents with chronic renal failure. The difference between elderly rural and urban 

Black beneficiaries was less than 3 percentage points, as was the difference between rural 

and urban elderly White beneficiaries. The difference between rural and urban elderly 

Hispanic beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† This includes cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) and nonaspirin NSAIDs.

 

 
108

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with Dementia

Percentage of MA enrollees aged 65 years and older with dementia who were not dispensed a 

prescription for a potentially harmful medication,† by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, use of potentially harmful medication 

was avoided less often for elderly rural residents with dementia than for elderly urban 

residents with dementia. The difference between elderly rural API beneficiaries and elderly 

urban API beneficiaries was less than 3 percentage points. The difference between elderly 

rural and urban Black beneficiaries was greater than 3 percentage points, as were the 

differences between elderly rural and urban Hispanic beneficiaries and elderly rural and 

urban White beneficiaries.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† This includes antiemetics, antipsychotics, benzodiazepines, tricyclic antidepressants, H2 receptor antagonists, 

nonbenzodiazepine hypnotics, and anticholinergic agents.

 

 

 
109

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with a History of Falls

Percentage of MA enrollees aged 65 years and older with a history of falls who were not dispensed 

a prescription for a potentially harmful medication,† by geography within racial and ethnic group, 

2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, Hispanic, and White beneficiaries, use of potentially harmful medication 

was avoided less often for elderly rural residents with a history of falls than for elderly 

urban residents with a history of falls. For each of these racial and ethnic groups, the

difference between rural and urban residents was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† This includes anticonvulsants, nonbenzodiazepine hypnotics, selective serotonin reuptake inhibitors, antiemetics, 

antipsychotics, benzodiazepines, and tricyclic antidepressants.

 
110

Avoiding Use of High-Risk Medications in the Elderly

Percentage of MA enrollees aged 65 years and older who were not prescribed a high-risk 

medication, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, and White beneficiaries, use of high-risk medication was avoided less 

often for elderly rural residents than for elderly urban residents. The difference between 

elderly rural and urban API beneficiaries was less than 3 percentage points, as was the 

difference between elderly rural and urban White beneficiaries. The difference between 

elderly rural and urban Black beneficiaries was greater than 3 percentage points.

o Among Hispanic beneficiaries, use of high-risk medication was avoided more often for 

elderly rural residents than for elderly urban residents. The difference between elderly

rural and urban Hispanic beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

 

 
111

Avoiding Use of Opioids at High Dosage

Percentage of MA enrollees aged 18 years and older who were not prescribed opioids at a high 

dosage† for more than 14 days, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API beneficiaries, use of opioids at a high dosage for more than 14 days was 

avoided less often for rural residents than for urban residents. The difference between 

rural and urban API beneficiaries was less than 3 percentage points.

o Among Black, Hispanic, and White beneficiaries, use of opioids at a high dosage for more 

than 14 days was avoided more often for rural residents than for urban residents. For each 

of these racial and ethnic groups, the difference between rural and urban residents was 

less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

† Average morphine equivalent dose > 120 mg. 

 

 
112

Avoiding Use of Opioids from Multiple Prescribers

Percentage of MA enrollees aged 18 years and older who did not receive prescriptions for opioids 

from four or more prescribers in the past year, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API beneficiaries, use of opioids from multiple prescribers was avoided about as

often for rural residents as for urban residents.

o Among Black, Hispanic, and White beneficiaries, use of opioids from multiple prescribers 

was avoided more often for rural residents than for urban residents. For each of these 

racial and ethnic groups, the difference between rural and urban residents was greater 

than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
113

Avoiding Use of Opioids from Multiple Pharmacies

Percentage of MA enrollees aged 18 years and older who did not receive prescriptions for opioids 

from four or more pharmacies in the past year, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API and Hispanic beneficiaries, use of opioids from multiple pharmacies was 

avoided less often for rural residents than for urban residents. The difference between 

rural and urban API beneficiaries was less than 3 percentage points. The difference 

between rural and urban Hispanic beneficiaries was greater than 3 percentage points.

o Among Black and White beneficiaries, use of opioids from multiple pharmacies was 

avoided more often for rural residents than for urban residents. The difference between 

rural and urban Black beneficiaries was greater than 3 percentage points. The difference 

between rural and urban White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents. 

 
114

Clinical Care: Access/Availability of Care

Older Adults’ Access to Preventive/Ambulatory Services

Percentage of MA enrollees aged 65 years and older who had an ambulatory or preventive care visit

in the past year, by geography within racial and ethnic group, 2019

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Among API, Black, and Hispanic beneficiaries, rural older adults were more likely than 

urban older adults to have had an ambulatory or preventive care visit. For each of these 

racial and ethnic groups, the difference between rural and urban older adults was less than 

3 percentage points.

o Among White beneficiaries, rural older adults were less likely than urban older adults to 

have had an ambulatory or preventive care visit. The difference between rural and urban 

White older adults was less than 3 percentage points.

_____________________________________

* Significantly different from the score for urban residents of the same racial and ethnic group (p < 0.05).

For statistically significant differences between rural and urban residents of the same race or ethnicity, the 

following symbols are also used when applicable:

(+) Difference is equal to or larger than 3 points (prior to rounding) and favors rural residents.

(-) Difference is equal to or larger than 3 points (prior to rounding) and favors urban residents.

 

 
Section III: 

Racial and Ethnic Disparities in 

Health Care in Medicare Within 

Urban and Rural Areas 
116

Racial and Ethnic Disparities in Care Within Urban and Rural Areas: 

All Patient Experience Measures, Medicare Advantage

Number of patient experience measures for which urban and rural residents of selected 

racial and ethnic minority groups reported experiences that were worse than, similar to, or better 

than the experiences reported by White urban and rural residents in 2019 

 

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such 

as Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as 

Hispanic regardless of races selected. 

Urban AI/AN MA beneficiaries had worse results than urban White MA beneficiaries

• Getting needed prescription drugs

Urban API MA beneficiaries had worse results than urban White MA beneficiaries

• Getting needed care

• Getting appointments and care quickly

• Customer service

• Doctors who communicate well

• Care coordination

• Getting needed prescription drugs

Urban API MA beneficiaries had better results than urban White MA beneficiaries

• Annual flu vaccine

Urban Black MA beneficiaries had worse results than urban White MA beneficiaries

• Annual flu vaccine
117

Urban Hispanic MA beneficiaries had worse results than urban White MA beneficiaries

• Getting appointments and care quickly

Rural AI/AN MA beneficiaries had worse results than rural White MA beneficiaries

• Getting needed care

• Care coordination

Rural API MA beneficiaries had worse results than rural White MA beneficiaries

• Getting needed care

• Getting appointments and care quickly

• Customer service

• Getting needed prescription drugs

Rural Black MA beneficiaries had worse results than rural White MA beneficiaries

• Annual flu vaccine

Rural Black MA beneficiaries had better results than rural White MA beneficiaries

• Customer service

Rural Hispanic MA beneficiaries had worse results than rural White MA beneficiaries

• Getting needed care
118

Racial and Ethnic Disparities in Care Within Urban and Rural Areas: 

All Patient Experience Measures, Fee-for-Service

Number of patient experience measures for which urban and rural residents of selected 

racial and ethnic minority groups reported experiences that were worse than, similar to, or better 

than the experiences reported by White urban and rural residents in 2019 

 

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected.

† For two patient experience measures, there were not enough data from urban FFS AI/AN beneficiaries to 

compare their experiences to those of urban FFS White beneficiaries.

‡ For one patient experience measure, there were not enough data from rural FFS AI/AN beneficiaries to 

compare their experiences to those of rural FFS White beneficiaries. For two patient experience measures, 

there were not enough data from rural FFS API beneficiaries to compare their experiences to those of rural 

FFS White beneficiaries.

Urban AI/AN FFS beneficiaries had worse results than urban White FFS beneficiaries

• Getting needed care

Urban API FFS beneficiaries had worse results than urban White FFS beneficiaries

• Getting needed care

• Getting appointments and care quickly

• Customer service

Urban API FFS beneficiaries had better results than urban White FFS beneficiaries

• Annual flu vaccine

 
119

Urban Black FFS beneficiaries had worse results than urban White FFS beneficiaries

• Annual flu vaccine

Urban Hispanic FFS beneficiaries had worse results than urban White FFS beneficiaries

• Getting appointments and care quickly

• Getting needed prescription drugs

• Annual flu vaccine

Rural AI/AN FFS beneficiaries had worse results than rural White FFS beneficiaries

• Getting needed care

• Getting appointments and care quickly

• Customer service

• Care coordination

Rural Black FFS beneficiaries had worse results than rural White FFS beneficiaries

• Annual flu vaccine

Rural Hispanic FFS beneficiaries had worse results than rural White FFS beneficiaries

• Annual flu vaccine
120

Patient Experience

Getting Needed Care

Percentage of the best possible score (on a 0–100 scale) earned on how easy it is for patients to get 

needed care,

† by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

 

 

 

 

 

 

 

 
121

Disparities

o AI/AN MA beneficiaries residing in urban areas reported experiences getting needed care 

that were similar to the experiences reported by White beneficiaries residing in urban 

areas. AI/AN FFS beneficiaries residing in urban areas reported experiences getting 

needed care that were worse‡ than the experiences reported by White FFS beneficiaries 

residing in urban areas. The difference between urban AI/AN and urban White FFS 

beneficiaries was greater than 3 points on a 0–100 scale.

o In both MA and FFS, AI/AN beneficiaries residing in rural areas reported experiences 

getting needed care that were worse than the experiences reported by White 

beneficiaries residing in rural areas. In each case, the difference between rural AI/AN and 

rural White beneficiaries was greater than 3 points on a 0–100 scale.

o In both MA and FFS, API beneficiaries residing in urban areas reported experiences 

getting needed care that were worse than the experiences reported by White 

beneficiaries residing in urban areas. In each case, the difference between urban API and 

urban White beneficiaries was greater than 3 points on a 0–100 scale.

o API MA beneficiaries residing in rural areas reported experiences getting needed care 

that were worse than the experiences reported by White MA beneficiaries residing in 

rural areas. The difference between rural API and rural White MA beneficiaries was 

greater than 3 points on a 0-100 scale. API FFS beneficiaries residing in rural areas 

reported experiences getting needed care that were similar to the experiences reported 

by White FFS beneficiaries residing in rural areas.

o In both MA and FFS, Black beneficiaries residing in urban areas reported experiences 

getting needed care that were similar to the experiences reported by White beneficiaries 

residing in urban areas.

o In both MA and FFS, Black beneficiaries residing in rural areas reported experiences 

getting needed care that were similar to the experiences reported by White beneficiaries 

residing in rural areas.

o In both MA and FFS, Hispanic beneficiaries residing in urban areas reported experiences 

getting needed care that were worse than the experiences reported by White 

beneficiaries residing in urban areas. The difference between urban Hispanic and urban 

White MA beneficiaries was less than 3 points on a 0–100 scale, as was the difference 

between urban Hispanic and urban White FFS beneficiaries.

o Hispanic MA beneficiaries residing in rural areas reported experiences getting needed 

care that were worse than the experiences reported by White MA beneficiaries residing

in urban areas. The difference between rural Hispanic and rural White MA beneficiaries 

was greater than 3 points on a 0–100 scale. Hispanic FFS beneficiaries residing in rural 

areas reported experiences getting needed care that were similar to the experiences 

reported by White FFS beneficiaries residing in rural areas.

_____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).
122

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes how often in the last six months patients got appointments with specialists as soon as they needed 

them and how easy it was to get needed care, tests, or treatment. ‡ Unlike on pages 116–119, we use the terms “better” or “worse” to describe all statistically significant differences 

on individual patient experience measures. We note in the “Disparities” section for each of these measures where 

differences are greater or less than 3 points.
123

Getting Appointments and Care Quickly

Percentage of the best possible score (on a 0–100 scale) earned on how quickly

patients get appointments and care,† by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

 

 

 

 

 

 

 

 

 

 
124

Disparities

o In both MA and FFS, urban AI/AN beneficiaries reported experiences with getting 

appointments and care quickly that were similar to the experiences reported by urban White 

beneficiaries.

o Rural AI/AN MA beneficiaries reported experiences with getting appointments and care 

quickly that were similar to the experiences reported by rural White MA beneficiaries. Rural 

AI/AN FFS beneficiaries reported worse experiences with getting appointments and care 

quickly than rural White FFS beneficiaries. The difference between rural AI/AN and rural 

White FFS beneficiaries was greater than 3 points on a 0–100 scale.

o In both MA and FFS, urban API beneficiaries reported worse experiences with getting 

appointments and care quickly than urban White beneficiaries. In each case, the difference 

between urban API and urban White beneficiaries was greater than 3 points on a 0–100 scale.

o Rural API MA beneficiaries reported worse experiences with getting appointments and care 

quickly than rural White MA beneficiaries. The difference between rural API and rural White 

MA beneficiaries was greater than 3 points on a 0–100 scale. Rural API FFS beneficiaries 

reported experiences with getting appointments and care quickly that were similar to the 

experiences reported by rural White FFS beneficiaries. 

o Urban Black MA beneficiaries reported experiences with getting appointments and care 

quickly that were similar to the experiences reported by urban White MA beneficiaries. Urban 

Black FFS beneficiaries reported worse experiences with getting appointments and care 

quickly than urban White FFS beneficiaries. The difference between urban Black and urban 

White FFS beneficiaries was less than 3 points on a 0–100 scale.

o In both MA and FFS, rural Black beneficiaries reported experiences with getting appointments 

and care quickly that were similar to the experiences reported by rural White beneficiaries. 

o In both MA and FFS, urban Hispanic beneficiaries reported worse experiences with getting 

appointments and care quickly than urban White beneficiaries. In each case, the difference 

between urban Hispanic and urban White beneficiaries was greater than 3 points on a 0–100 

scale.

o Rural Hispanic MA beneficiaries reported experiences with getting appointments and care 

quickly that were similar to the experiences reported by rural White MA beneficiaries. Rural 

Hispanic FFS beneficiaries reported worse experiences with getting appointments and care 

quickly than rural White FFS beneficiaries. The difference between rural Hispanic and rural 

White FFS beneficiaries was less than 3 points on a 0–100 scale.

_____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes how often in the last six months patients got care that was needed right away, as well as how easy it 

was to get appointments for checkups and routine care.
125

Customer Service

Percentage of the best possible score (on a 0–100 scale) earned on three aspects of customer service,

†

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from urban AI/AN FFS beneficiaries or rural API FFS beneficiaries to compare 

these groups to White beneficiaries on this measure.

 

 

 

 
126

Disparities

o Urban AI/AN MA beneficiaries reported experiences with customer service that were similar 

to the experiences reported by urban White beneficiaries.

o Rural AI/AN MA beneficiaries reported experiences with customer service that were similar to 

the experiences reported by rural White beneficiaries. Rural AI/AN FFS beneficiaries reported 

worse experiences with customer service than rural White FFS beneficiaries. The difference 

between rural AI/AN and rural White FFS beneficiaries was greater than 3 points on a 0–100 

scale.

o In both MA and FFS, urban API beneficiaries reported worse experiences with customer 

service than urban White beneficiaries. In each case, the difference between urban API and 

urban White beneficiaries was greater than 3 points on a 0–100 scale.

o Rural API MA beneficiaries reported worse experiences with customer service than rural 

White MA beneficiaries. The difference between rural API and rural White MA beneficiaries 

was greater than 3 points on a 0–100 scale.

o In both MA and FFS, urban Black beneficiaries reported experiences with customer service 

that were similar to the experiences reported by urban White beneficiaries.

o Rural Black MA beneficiaries reported better experiences with customer service than rural

White MA beneficiaries. The difference between rural Black and rural White MA beneficiaries 

was greater than 3 points on a 0–100 scale. Rural Black FFS beneficiaries reported 

experiences with customer service that were similar to the experiences reported by rural

White FFS beneficiaries.

o In both MA and FFS, urban Hispanic beneficiaries reported experiences with customer service

that were similar to the experiences reported by urban White beneficiaries.

o In both MA and FFS, rural Hispanic beneficiaries reported experiences with customer service 

that were similar to the experiences reported by rural White beneficiaries.

_____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes how often in the last six months health plan customer service staff provided the information or help 

that beneficiaries needed, how often beneficiaries were treated with courtesy and respect, and how often forms 

from the health plan were easy to fill out.
127

Doctors Who Communicate Well

Percentage of the best possible score (on a 0–100 scale) earned on how well doctors communicate 

with patients,

† by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

 

 

 

 

 

 
128

Disparities

o In both MA and FFS, urban AI/AN beneficiaries reported experiences with doctor 

communication that were similar to the experiences reported by urban White beneficiaries.

o In both MA and FFS, rural AI/AN beneficiaries reported experiences with doctor 

communication that were similar to the experiences reported by rural White beneficiaries.

o In both MA and FFS, urban API beneficiaries reported worse experiences with doctor 

communication than urban White beneficiaries. The difference between urban API and urban 

White MA beneficiaries was greater than 3 points on a 0–100 scale. The difference between 

urban API and urban White FFS beneficiaries was less than 3 points on a 0–100 scale.

o In both MA and FFS, rural API beneficiaries reported experiences with doctor communication 

that were similar to the experiences reported by rural White beneficiaries.

o In both MA and FFS, urban Black beneficiaries reported experiences with doctor 

communication that were similar to the experiences reported by urban White beneficiaries.

o Rural Black MA beneficiaries reported experiences with doctor communication that were 

similar to the experiences reported by rural White MA beneficiaries. Rural Black FFS 

beneficiaries reported better experiences with doctor communication than rural White FFS 

beneficiaries. The difference between rural Black and rural White FFS beneficiaries was less 

than 3 points on a 0–100 scale.

o In both MA and FFS, urban Hispanic beneficiaries reported experiences with doctor 

communication that were similar to the experiences reported by urban White beneficiaries.

o In both MA and FFS, rural Hispanic beneficiaries reported experiences with doctor 

communication that were similar to the experiences reported by rural White beneficiaries.

_____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes how often in the last six months doctors explained things in a way that was easy to understand, 

listened carefully, showed respect for what patients had to say, and spent time with patients.
129

Care Coordination

Percentage of the best possible score (on a 0–100 scale) earned on how well patient care is 

coordinated,† by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected.

‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

 

 

 

 
130

Disparities

o In both MA and FFS, urban AI/AN beneficiaries reported experiences with care coordination 

that were similar to the experiences reported by urban White beneficiaries.

o In both MA and FFS, rural AI/AN MA beneficiaries reported worse experiences with care 

coordination than rural White MA beneficiaries. In each case, the difference between rural

AI/AN and rural White beneficiaries was greater than 3 points on a 0–100 scale.

o In both MA and FFS, urban API beneficiaries reported worse experiences with care 

coordination than urban White beneficiaries. The difference between urban API and urban 

White MA beneficiaries was greater than 3 points on a 0–100 scale. The difference between 

urban API and urban White FFS beneficiaries was less than 3 points on a 0–100 scale.

o In both MA and FFS, rural API beneficiaries reported experiences with care coordination that 

were similar to the experiences reported by rural White beneficiaries.

o In both MA and FFS, urban Black beneficiaries reported experiences with care coordination 

that were similar to the experiences reported by urban White beneficiaries. 

o In both MA and FFS, rural Black beneficiaries reported experiences with care coordination 

that were similar to the experiences reported by rural White beneficiaries.

o In both MA and FFS, urban Hispanic beneficiaries reported worse experiences with care 

coordination than urban White beneficiaries. In each case, the difference between urban 

Hispanic and urban White beneficiaries was less than 3 points on a 0–100 scale.

o In both MA and FFS, rural Hispanic beneficiaries reported experiences with care coordination 

that were similar to the experiences reported by rural White beneficiaries.

_____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes how often in the last six months doctors had medical records and other information about patients’ 

care at patients’ scheduled appointments and how quickly patients received their test results.
131

Getting Needed Prescription Drugs

Percentage of the best possible score (on a 0–100 scale) earned on how easy it is for beneficiaries to 

get the prescription drugs they need using their plans,† by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from urban AI/AN FFS beneficiaries, rural AI/AN FFS beneficiaries, or rural API 

FFS beneficiaries to compare these groups to White beneficiaries on this measure.

 

 

 

 

 

 
132

Disparities

o Urban AI/AN MA beneficiaries reported worse experiences getting needed prescription drugs 

than urban White MA beneficiaries. The difference between urban AI/AN and urban White 

MA beneficiaries was greater than 3 points on a 0–100 scale.

o Rural AI/AN MA beneficiaries reported experiences getting needed prescription drugs that 

were similar to the experiences reported by rural White MA beneficiaries. 

o Urban API MA beneficiaries reported worse experiences getting needed prescription drugs 

than urban White MA beneficiaries. The difference between urban API and urban White MA 

beneficiaries was greater than 3 points on a 0–100 scale. Urban API FFS beneficiaries reported 

experiences getting needed prescription drugs that were similar to the experiences reported 

by urban White FFS beneficiaries.

o Rural API MA beneficiaries reported worse experiences getting needed prescription drugs 

than rural White MA beneficiaries. The difference between rural API and rural White MA 

beneficiaries was greater than 3 points on a 0–100 scale.

o In both MA and FFS, urban Black beneficiaries reported experiences getting needed 

prescription drugs that were similar to the experiences reported by urban White 

beneficiaries.

o In both MA and FFS, rural Black beneficiaries reported experiences getting needed 

prescription drugs that were similar to the experiences reported by rural White beneficiaries.

o In both MA and FFS, urban Hispanic MA beneficiaries reported worse experiences getting 

needed prescription drugs than urban White beneficiaries. The difference between urban 

Hispanic and urban White MA beneficiaries was less than 3 points on a 0–100 scale. The 

difference between urban Hispanic and urban White FFS beneficiaries was greater than 3 

points on a 0–100 scale. 

o In both MA and FFS, rural Hispanic beneficiaries reported experiences getting needed 

prescription drugs that were similar to the experiences reported by rural White beneficiaries.

_____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes how often in the last six months it was easy to use the plan to get prescribed medications and how 

easy it was to fill prescriptions at a pharmacy or by mail.
133

Annual Flu Vaccine

Percentage of Medicare enrollees who got a vaccine (flu shot),

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Data from the 2019 Medicare CAHPS survey.

NOTES: AI/AN = American Indian or Alaska Native. API = Asian or Pacific Islander. Racial groups such as 

Black and White are non-Hispanic. Those who endorsed Hispanic ethnicity were classified as Hispanic 

regardless of races selected.

† This score is based on fewer than 400 completed measures, and thus its precision may be low.

 

 

 

 

 

 
134

Disparities

o In both MA and FFS, urban AI/AN beneficiaries were about as likely as urban White 

beneficiaries to have received the flu vaccine.

o In both MA and FFS, rural AI/AN beneficiaries were about as likely as rural White beneficiaries 

to have received the flu vaccine.

o In both MA and FFS, urban API beneficiaries were more likely than urban White beneficiaries 

to have received the flu vaccine. In each case, the difference between urban API and urban 

White beneficiaries was greater than 3 percentage points.

o In both MA and FFS, rural API beneficiaries were about as likely as rural White beneficiaries to 

have received the flu vaccine.

o In both MA and FFS, urban Black beneficiaries were less likely than urban White beneficiaries 

to have received the flu vaccine. In each case, the difference between urban Black and urban 

White beneficiaries was greater than 3 percentage points.

o In both MA and FFS, rural Black beneficiaries were less likely than rural White beneficiaries to 

have received the flu vaccine. In each case, the difference between rural Black and rural 

White beneficiaries was greater than 3 percentage points.

o Urban Hispanic MA beneficiaries were about as likely as urban White MA beneficiaries to 

have received the flu vaccine. Urban Hispanic FFS beneficiaries were less likely than urban 

White FFS beneficiaries to have received the flu vaccine. The difference between urban 

Hispanic and urban White FFS beneficiaries was greater than 3 percentage points.

o Rural Hispanic MA beneficiaries were about as likely as rural White MA beneficiaries to have 

received the flu vaccine. Rural Hispanic FFS beneficiaries were less likely than rural White FFS 

beneficiaries to have received the flu vaccine. The difference between rural Hispanic and rural

White FFS beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
135

Racial and Ethnic Disparities in Care Within Urban and Rural Areas: 

All Clinical Care Measures

Number of clinical care measures for which urban and rural residents of selected 

racial and ethnic minority groups had results that were worse than, similar to, or better than results 

for White urban and rural residents in 2019 

 

 

SOURCE: This chart summarizes clinical quality (HEDIS) data collected in 2019 from MA plans 

nationwide.

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; 

Hispanic ethnicity includes all races. Clinical quality data are not available for Medicare FFS 

beneficiaries.

† There were only enough data from rural API beneficiaries to make rural-urban comparisons on 34 

of the 39 clinical care measures.

Urban API beneficiaries had worse results than urban White beneficiaries 

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Initiation of alcohol and other drug dependence treatment

• Medication reconciliation after hospital discharge
136

Urban API beneficiaries had better results than urban White beneficiaries 

• Pharmacotherapy management of COPD exacerbation—use of bronchodilators

• Diabetes care—eye exam

• Diabetes care—blood pressure controlled

• Diabetes care—blood sugar controlled

• Statin use in patients with diabetes

• Osteoporosis management in women who had a fracture

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

• Avoiding use of high-risk medication in the elderly

• Avoiding use of opioids at high dosage

Urban Black beneficiaries had worse results than urban White beneficiaries 

• Controlling high blood pressure

• Continuous beta-blocker treatment after a heart attack

• Medication adherence for cardiovascular disease—statins

• Diabetes care—blood pressure controlled

• Diabetes care—blood sugar controlled

• Medication adherence for diabetes—statins

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Follow-up after hospital stay for mental illness (within 30 days of discharge)

• Follow-up after emergency department visit for mental illness (within 30 days of discharge)

• Follow-up after emergency department visit for alcohol and other drug abuse or dependence (within 30 

days of discharge)

• Medication reconciliation after hospital discharge

• Transitions of care—notification of inpatient admission

• Transitions of care—receipt of discharge information

• Follow-up after emergency department visit for people with high-risk multiple chronic conditions

• Avoiding potentially harmful drug-disease interactions in elderly patients with chronic renal failure

Urban Black beneficiaries had better results than urban White beneficiaries 

• Breast cancer screening

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

Urban Hispanic beneficiaries had worse results than urban White beneficiaries 

• Continuous beta-blocker treatment after a heart attack

• Medication adherence for cardiovascular disease—statins

• Medication adherence for diabetes—statins

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Follow-up after emergency department visit for mental illness (within 30 days of discharge)

• Initiation of alcohol and other drug dependence treatment

• Transitions of care—notification of inpatient admission

• Transitions of care—receipt of discharge information

• Avoiding potentially harmful drug-disease interactions in elderly patients with chronic renal failure

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia
137

Urban Hispanic beneficiaries had better results than urban White beneficiaries 

• Breast cancer screening

• Testing to confirm COPD

• Pharmacotherapy management of COPD exacerbation—use of bronchodilators

• Diabetes care—eye exam

• Statin use in patients with diabetes

• Osteoporosis management in women who had a fracture

Rural API beneficiaries had worse results than rural White beneficiaries 

• Antidepressant medication management—acute phase treatment

Rural API beneficiaries had better results than rural White beneficiaries 

• Diabetes care—kidney disease monitoring

• Diabetes care—blood sugar controlled

• Statin use in patients with diabetes

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

• Avoiding use of high-risk medications in the elderly

Rural Black beneficiaries had worse results than rural White beneficiaries 

• Pharmacotherapy management of COPD exacerbation—systemic corticosteroid

• Controlling high blood pressure

• Continuous beta-blocker treatment after a heart attack

• Medication adherence for cardiovascular disease—statins

• Diabetes care—blood pressure controlled

• Medication adherence for diabetes—statins

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Follow-up after hospital stay for mental illness (within 30 days of discharge)

• Follow-up after emergency department visit for mental illness (within 30 days of discharge)

• Follow-up after emergency department visit for alcohol and other drug abuse or dependence (within 30 

days of discharge)

• Initiation of alcohol and other drug dependence treatment

• Transitions of care—notification of inpatient admission

• Transitions of care—receipt of discharge information

• Avoiding potentially harmful drug-disease interactions in elderly patients with chronic renal failure

Rural Black beneficiaries had better results than rural White beneficiaries 

• Breast cancer screening

• Diabetes care—eye exam

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls
138

Rural Hispanic beneficiaries had worse results than rural White beneficiaries 

• Pharmacotherapy management of COPD exacerbation—systemic corticosteroid

• Pharmacotherapy management of COPD exacerbation—bronchodilator

• Continuous beta-blocker treatment after a heart attack

• Medication adherence for cardiovascular disease—statins

• Medication adherence for diabetes—statins

• Antidepressant medication management—acute phase treatment

• Antidepressant medication management—continuation phase treatment

• Follow-up after emergency department visit for alcohol and other drug abuse or dependence (within 30 

days of discharge)

• Initiation of alcohol and other drug dependence treatment

• Engagement of alcohol and other drug dependence treatment

• Medication reconciliation after hospital discharge

• Transitions of care—notification of inpatient admission

• Transitions of care—receipt of discharge information

• Follow-up after emergency department visit for people with high-risk multiple chronic conditions

• Avoiding potentially harmful drug-disease interactions in elderly patients with chronic renal failure

• Avoiding potentially harmful drug-disease interactions in elderly patients with dementia

• Avoiding potentially harmful drug-disease interactions in elderly patients with a history of falls

• Avoiding use of opioids from multiple pharmacies

Rural Hispanic beneficiaries had better results than rural White beneficiaries 

• Breast cancer screening

• Colorectal cancer screening

• Testing to confirm COPD

• Controlling high blood pressure

• Diabetes care—eye exam

• Diabetes care—kidney disease monitoring

• Diabetes care—blood pressure controlled

• Statin use in patients with diabetes

• Osteoporosis management in women who had a fracture

• Follow-up after hospital stay for mental illness (within 30 days of discharge)

• Avoiding use of opioids at high dosage

• Avoiding use of opioids from multiple prescribers
139

Clinical Care: Prevention and Screening

Adult BMI Assessment

Percentage of MA enrollees aged 18 to 74 years who had an outpatient visit whose body mass 

index (BMI) was documented in the past two years, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, API beneficiaries were about as likely as White beneficiaries 

to have had their BMIs documented.

o In both urban and rural areas, Black beneficiaries were about as likely as White 

beneficiaries to have had their BMIs documented. 

o Urban Hispanic beneficiaries were more likely than urban White beneficiaries to have had 

their BMIs documented. The difference between urban Hispanic and urban White 

beneficiaries was less than 3 percentage points. Rural Hispanic beneficiaries were about as

likely as rural White beneficiaries to have had their BMIs documented.

___________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 
140

Breast Cancer Screening

Percentage of MA enrollees (women) aged 50 to 74 years who had appropriate screening for breast 

cancer, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API women were more likely than urban White women to have been appropriately 

screened for breast cancer. The difference between urban API and urban White women

was less than 3 percentage points. Rural API women were about as likely as rural White 

women to have been appropriately screened for breast cancer.

o In both urban and rural areas, Black women were more likely than White women to have 

been appropriately screened for breast cancer. In each case, the difference between Black 

and White women was greater than 3 percentage points.

o In both urban and rural areas, Hispanic women were more likely than White women to 

have been appropriately screened for breast cancer. In each case, the difference between 

Hispanic and White women was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 

 
141

Colorectal Cancer Screening

Percentage of MA enrollees aged 50 to 75 years who had appropriate screening for

colorectal cancer, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities 

o In both urban and rural areas, API beneficiaries were about as likely as White 

beneficiaries to have been appropriately screened for colorectal cancer.

o Urban Black beneficiaries were more likely than urban White beneficiaries to have 

been appropriately screened for colorectal cancer. The difference between urban Black 

and urban White beneficiaries was less than 3 percentage points. Rural Black 

beneficiaries were about as likely as rural White beneficiaries to have been 

appropriately screened for colorectal cancer.

o Urban Hispanic beneficiaries were about as likely as urban White beneficiaries to have 

been appropriately screened for colorectal cancer. Rural Hispanic beneficiaries were 

more likely than rural White beneficiaries to have been appropriately screened for 

colorectal cancer. The difference between rural Hispanic and rural White beneficiaries 

was greater than 3 percentage points.

____________________________________

* Significantly different from the score for White residents of the same locality and coverage type (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality and coverage type, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 
142

Clinical Care: Respiratory Conditions

Testing to Confirm COPD

Percentage of MA enrollees aged 40 years and older with a new diagnosis of chronic obstructive 

pulmonary disease (COPD) or newly active COPD who received appropriate spirometry testing to 

confirm the diagnosis, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries with a new diagnosis of COPD or newly active COPD were less likely 

than urban White beneficiaries with a new diagnosis of COPD or newly active COPD to have 

received a spirometry test to confirm the diagnosis. The difference between urban API and 

urban White beneficiaries was less than 3 percentage points. Rural API beneficiaries with a 

new diagnosis of COPD or newly active COPD were about as likely as rural White 

beneficiaries with a new diagnosis of COPD or newly active COPD to have received a 

spirometry test to confirm the diagnosis. 

o Urban Black beneficiaries with a new diagnosis of COPD or newly active COPD were less 

likely than urban White beneficiaries with a new diagnosis of COPD or newly active COPD 

to have received a spirometry test to confirm the diagnosis. The difference between urban 

Black and urban White beneficiaries was less than 3 percentage points. Rural Black 

beneficiaries with a new diagnosis of COPD or newly active COPD were about as likely as 

rural White beneficiaries with a new diagnosis of COPD or newly active COPD to have 

received a spirometry test to confirm the diagnosis.

o In both urban and rural areas, Hispanic beneficiaries with a new diagnosis of COPD or 

newly active COPD were more likely than White beneficiaries with a new diagnosis of COPD 

or newly active COPD to have received a spirometry test to confirm the diagnosis. In each 

 

 

 
143

case, the difference between Hispanic and White beneficiaries was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
144

Clinical Care: Pharmacotherapy Management of COPD

Exacerbation—Systemic Corticosteroid

Percentage of MA enrollees aged 40 years and older who had an acute inpatient discharge or 

emergency department encounter for COPD exacerbation in the past year who were dispensed a 

systemic corticosteroid within 14 days of the event, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries who experienced a COPD exacerbation were more likely than urban 

White beneficiaries who experienced a COPD exacerbation to have been dispensed a 

systemic corticosteroid within 14 days of the event. The difference between urban API and 

urban White beneficiaries was less than 3 percentage points. Rural API beneficiaries who 

experienced a COPD exacerbation were less likely than rural White beneficiaries who 

experienced a COPD exacerbation to have been dispensed a systemic corticosteroid within 

14 days of the event. The difference between rural API and rural White beneficiaries was 

less than 3 percentage points.

o In both urban and rural areas, Black beneficiaries who experienced a COPD exacerbation 

were less likely than White beneficiaries who experienced a COPD exacerbation to have 

been dispensed a systemic corticosteroid within 14 days of the event. The difference 

between urban Black and urban White beneficiaries was less than 3 percentage points. The 

difference between rural Black and rural White beneficiaries was greater than 3 percentage 

points.

o In both urban and rural areas, Hispanic beneficiaries who experienced a COPD exacerbation 

were less likely than White beneficiaries who experienced a COPD exacerbation to have 

been dispensed a systemic corticosteroid within 14 days of the event. The difference 

 

 

 
145

between urban Hispanic and urban White beneficiaries was less than 3 percentage points. 

The difference between rural Hispanic and rural White beneficiaries was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
146

Clinical Care: Pharmacotherapy Management of COPD

Exacerbation—Bronchodilator

Percentage of MA enrollees aged 40 years and older who had an acute inpatient discharge or 

emergency department encounter for COPD exacerbation in the past year who were dispensed a 

bronchodilator within 30 days of experiencing the event, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o In both urban and rural areas, API beneficiaries who experienced a COPD exacerbation 

were more likely than White beneficiaries who experienced a COPD exacerbation to have 

been dispensed a bronchodilator within 30 days of the event. The difference between 

urban API and urban White beneficiaries was greater than 3 percentage points. The 

difference between rural API and rural White beneficiaries was less than 3 percentage 

points.

o Urban Black beneficiaries who experienced a COPD exacerbation were more likely than 

urban White beneficiaries who experienced a COPD exacerbation to have been dispensed a 

bronchodilator within 30 days of the event. The difference between urban Black and urban 

White beneficiaries was less than 3 percentage points. Rural Black beneficiaries who 

experienced a COPD exacerbation were less likely than rural White beneficiaries who 

experienced a COPD exacerbation to have been dispensed a bronchodilator within 30 days 

of the event. The difference between rural Black and rural White beneficiaries was less 

than 3 percentage points.

o Urban Hispanic beneficiaries who experienced a COPD exacerbation were more likely than 

urban White beneficiaries who experienced a COPD exacerbation to have been dispensed a 

 

 

 
147

bronchodilator within 30 days of the event. The difference between urban Hispanic and 

urban White beneficiaries was greater than 3 percentage points. Rural Hispanic 

beneficiaries who experienced a COPD exacerbation were less likely than rural White 

beneficiaries who experienced a COPD exacerbation to have been dispensed a 

bronchodilator within 30 days of the event. The difference between rural Hispanic and 

rural White beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
148

Clinical Care: Cardiovascular Conditions

Controlling High Blood Pressure

Percentage of MA enrollees aged 18 to 85 years who had a diagnosis of hypertension whose blood 

pressure was adequately controlled† during the past year, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries who had a diagnosis of hypertension were more likely than urban 

White beneficiaries who had a diagnosis of hypertension to have had their blood pressure 

adequately controlled. The difference between urban API and urban White beneficiaries was 

less than 3 percentage points. Rural API beneficiaries who had a diagnosis of hypertension 

were about as likely as rural White beneficiaries who had a diagnosis of hypertension to have 

had their blood pressure adequately controlled. 

o In both urban and rural areas, Black beneficiaries who had a diagnosis of hypertension were 

less likely than White beneficiaries who had a diagnosis of hypertension to have had their 

blood pressure adequately controlled. In each case, the difference between Black and White 

beneficiaries was greater than 3 percentage points.

o Urban Hispanic beneficiaries who had a diagnosis of hypertension were about as likely as

urban White beneficiaries who had a diagnosis of hypertension to have had their blood 

pressure adequately controlled. Rural Hispanic beneficiaries who had a diagnosis of 

hypertension were more likely than rural White beneficiaries who had a diagnosis of 

hypertension to have had their blood pressure adequately controlled. The difference between 

rural Hispanic and rural White beneficiaries was greater than 3 percentage points.

 

 
149

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Less than 140/90 for enrollees 18 to 59 years of age and for enrollees 60 to 85 years of age with a diagnosis of 

diabetes, or less than 150/90 for members 60 to 85 years of age without a diagnosis of diabetes.
150

Continuous Beta-Blocker Treatment

Percentage of MA enrollees aged 18 years and older who were hospitalized and discharged alive 

with a diagnosis of acute myocardial infarction (AMI) who received persistent beta-blocker 

treatment for six months after discharge, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † There were not enough data from rural API beneficiaries to compare them to White beneficiaries on this 

measure. 

Disparities

o Urban API beneficiaries who were hospitalized for a heart attack were about as likely as

urban White beneficiaries who were hospitalized for a heart attack to have received 

persistent beta-blocker treatment. 

o In both urban and rural areas, Black beneficiaries who were hospitalized for a heart attack 

were less likely than White beneficiaries who were hospitalized for a heart attack to have

received persistent beta-blocker treatment. In each case, the difference between Black and 

White beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, Hispanic beneficiaries who were hospitalized for a heart 

attack were less likely than White beneficiaries who were hospitalized for a heart attack to 

have received persistent beta-blocker treatment. In each case, the difference between 

Hispanic and White beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 
151

Statin Use in Patients with Cardiovascular Disease

Percentage of male MA enrollees aged 21 to 75 years and female MA enrollees aged 40 to 75 years 

with clinical atherosclerotic cardiovascular disease (ASCVD) who received statin therapy, 

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API beneficiaries with ASCVD were more likely than urban White beneficiaries with 

ASCVD to have received statin therapy. The difference between urban API and urban White 

beneficiaries was less than 3 percentage points. Rural API beneficiaries with ASCVD were 

about as likely as rural White beneficiaries with ASCVD to have received statin therapy. 

o Urban Black beneficiaries with ASCVD were less likely than urban White beneficiaries with 

ASCVD to have received statin therapy. The difference between urban Black and urban 

White beneficiaries was less than 3 percentage points. Rural Black beneficiaries with ASCVD

were about as likely as rural White beneficiaries with ASCVD to have received statin 

therapy.

o In both urban and rural areas, Hispanic beneficiaries with ASCVD were more likely than 

White beneficiaries with ASCVD to have received statin therapy. In each case, the 

difference between Hispanic and White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 
152

Medication Adherence for Cardiovascular Disease—Statins

Percentage of male MA enrollees aged 21 to 75 years and female MA enrollees aged 40 to 75 years 

with clinical atherosclerotic cardiovascular disease (ASCVD) who were dispensed a statin 

medication during the measurement year who remained on the medication for at least 80 percent 

of the treatment period, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API beneficiaries with ASCVD were less likely than urban White beneficiaries with 

ASCVD to have had proper statin medication adherence. The difference between urban API 

and urban White beneficiaries was less than 3 percentage points. Rural API beneficiaries 

with ASCVD were about as likely as rural White beneficiaries with ASCVD to have had 

proper statin medication adherence. 

o In both urban and rural areas, Black beneficiaries with ASCVD were less likely than White 

beneficiaries with ASCVD to have had proper statin medication adherence. In each case, 

the difference between Black and White beneficiaries was greater than 3 percentage 

points. 

o In both urban and rural areas, Hispanic beneficiaries with ASCVD were less likely than 

White beneficiaries with ASCVD to have had proper statin medication adherence. In each 

case, the difference between Hispanic and White beneficiaries was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 

 
153

Clinical Care: Diabetes

Diabetes Care—Blood Sugar Testing

Percentage of Medicare Advantage enrollees aged 18 to 75 years with diabetes (type 1 and type 2) who 

had one or more HbA1c tests in the past year, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, API beneficiaries with diabetes were more likely than White 

beneficiaries with diabetes to have had their blood sugar tested at least once in the past year. 

In each case, the difference between API and White beneficiaries was less than 3 percentage 

points.

o Urban Black beneficiaries with diabetes were less likely than urban White beneficiaries with 

diabetes to have had their blood sugar tested at least once in the past year. The difference 

between urban Black and urban White beneficiaries was less than 3 percentage points. Rural 

Black beneficiaries with diabetes were about as likely as rural White beneficiaries with 

diabetes to have had their blood sugar tested at least once in the past year. 

o Urban Hispanic beneficiaries with diabetes were more likely than urban White beneficiaries 

with diabetes to have had their blood sugar tested at least once in the past year. The 

difference between urban Hispanic and urban White beneficiaries was less than 3 percentage 

points. Rural Hispanic beneficiaries with diabetes were less likely than rural White beneficiaries 

with diabetes to have had their blood sugar tested at least once in the past year. The 

difference between rural Hispanic and rural White beneficiaries was less than 3 percentage 

points.

 

 

 
154

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
155

Diabetes Care—Eye Exam

Percentage of Medicare Advantage enrollees aged 18 to 75 years with diabetes (type 1 and type 2) who 

had an eye exam (retinal) in the past year, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API beneficiaries with diabetes were more likely than urban White beneficiaries with 

diabetes to have had an eye exam in the past year. The difference between urban API and 

urban White beneficiaries was greater than 3 percentage points. Rural API beneficiaries with 

diabetes were about as likely as rural White beneficiaries with diabetes to have had an eye 

exam in the past year.

o In both urban and rural areas, Black beneficiaries with diabetes were more likely than urban 

White beneficiaries with diabetes to have had an eye exam in the past year. The difference 

between urban Black and urban White beneficiaries was less than 3 percentage points. The 

difference between rural Black and rural White beneficiaries was greater than 3 percentage 

points.

o In both urban and rural areas, Hispanic beneficiaries with diabetes were more likely than 

White beneficiaries with diabetes to have had an eye exam in the past year. In each case, the 

difference between Hispanic and White beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 
156

Diabetes Care—Kidney Disease Monitoring

Percentage of Medicare Advantage enrollees aged 18 to 75 years with diabetes

(type 1 and type 2) who had medical attention for nephropathy in the past year, 

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, API beneficiaries with diabetes were more likely than White 

beneficiaries with diabetes to have had medical attention for nephropathy in the past year. 

The difference between urban API and urban White beneficiaries was less than 3 percentage 

points. The difference between rural API and rural White beneficiaries was greater than 3 

percentage points. 

o Urban Black beneficiaries with diabetes were more likely than urban White beneficiaries with 

diabetes to have had medical attention for nephropathy in the past year. The difference 

between urban Black and urban White beneficiaries was less than 3 percentage points. Rural 

Black beneficiaries with diabetes were about as likely as rural White beneficiaries with 

diabetes to have had medical attention for nephropathy in the past year. 

o In both urban and rural areas, Hispanic beneficiaries with diabetes were more likely than 

urban White beneficiaries with diabetes to have had medical attention for nephropathy in the 

past year. The difference between urban Hispanic and urban White beneficiaries was less than 

3 percentage points. The difference between rural Hispanic and rural White beneficiaries was 

greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 
157

Diabetes Care—Blood Pressure Controlled

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) whose most recent 

blood pressure was less than 140/90, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API beneficiaries with diabetes were more likely than urban White beneficiaries with 

diabetes to have their blood pressure under control. The difference between urban API and 

urban White beneficiaries was greater than 3 percentage points. Rural API beneficiaries with 

diabetes were about as likely as rural White beneficiaries with diabetes to have their blood 

pressure under control.

o In both urban and rural areas, Black beneficiaries with diabetes were less likely than White 

beneficiaries with diabetes to have their blood pressure under control. In each case, the 

difference between Black and White beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, Hispanic beneficiaries with diabetes were more likely than 

White beneficiaries with diabetes to have their blood pressure under control. The difference 

between urban Hispanic and urban White beneficiaries was less than 3 percentage points. The 

difference between rural Hispanic and rural White beneficiaries was greater than 3 percentage 

points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 
158

Diabetes Care—Blood Sugar Controlled

Percentage of MA enrollees aged 18 to 75 years with diabetes (type 1 and type 2) whose most recent 

HbA1c level was 9 percent or less, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, API beneficiaries with diabetes were more likely than urban 

White beneficiaries with diabetes to have their blood sugar levels under control. In each case, 

the difference between API and White beneficiaries was greater than 3 percentage points.

o Urban Black beneficiaries with diabetes were less likely than urban White beneficiaries with 

diabetes to have their blood sugar levels under control. The difference between urban Black 

and urban White beneficiaries was greater than 3 percentage points. Rural Black beneficiaries 

with diabetes about as less likely as rural White beneficiaries with diabetes to have their blood 

sugar levels under control.

o Urban Hispanic beneficiaries with diabetes were less likely than urban White beneficiaries with 

diabetes to have their blood sugar levels under control. The difference between urban 

Hispanic and urban White beneficiaries was less than 3 percentage points. Rural Hispanic 

beneficiaries with diabetes were about as likely as rural White beneficiaries with diabetes to 

have their blood sugar levels under control.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 

 
159

Statin Use in Patients with Diabetes

Percentage of MA enrollees aged 40 to 75 years with diabetes (type 1 and type 2)† who received statin 

therapy, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, API beneficiaries with diabetes were more likely than White 

beneficiaries with diabetes to have received statin therapy. In each case, the difference 

between API and White beneficiaries was greater than 3 percentage points.

o Urban Black beneficiaries with diabetes were about as likely as urban White beneficiaries with 

diabetes to have received statin therapy. Rural Black beneficiaries with diabetes were more

likely than rural White beneficiaries with diabetes to have received statin therapy. The 

difference between rural Black and rural White beneficiaries was less than 3 percentage 

points.

o In both urban and rural areas, Hispanic beneficiaries with diabetes were more likely than 

White beneficiaries with diabetes to have received statin therapy. In each case, the difference 

between Hispanic and White beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Excludes those who also have clinical atherosclerotic cardiovascular disease.

 

 
160

Medication Adherence for Diabetes—Statins

Percentage of MA enrollees aged 40 to 75 years with diabetes (type 1 and type 2)† who were dispensed 

a statin medication during the measurement year who remained on the medication for at least 80 

percent of the treatment period, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API beneficiaries with diabetes were less likely than urban White beneficiaries with 

diabetes to have had proper statin medication adherence. The difference between urban API 

and urban White beneficiaries was less than 3 percentage points. Rural API beneficiaries with 

diabetes were about as likely as rural White beneficiaries with diabetes to have had proper 

statin medication adherence.

o In both urban and rural areas, Black beneficiaries with diabetes were less likely than White 

beneficiaries with diabetes to have had proper statin medication adherence. In each case, the

difference between Black and White beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, Hispanic beneficiaries with diabetes were less likely than White 

beneficiaries with diabetes to have had proper statin medication adherence. In each case, the

difference between Hispanic and White beneficiaries was greater than 3 percentage points. _____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Excludes those who also have clinical atherosclerotic cardiovascular disease.

 

 

 

 
161

Clinical Care: Musculoskeletal Conditions

Rheumatoid Arthritis Management

Percentage of MA enrollees aged 18 years and older who were diagnosed with rheumatoid arthritis 

during the past year who were dispensed at least one ambulatory prescription for a disease-modifying 

antirheumatic drug (DMARD), by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries who were diagnosed with rheumatoid arthritis were more likely than 

urban White beneficiaries who were diagnosed with rheumatoid arthritis to have been 

dispensed at least one DMARD. The difference between urban API and urban White 

beneficiaries was less than 3 percentage points. Rural API beneficiaries who were diagnosed 

with rheumatoid arthritis were about as likely as rural White beneficiaries who were diagnosed 

with rheumatoid arthritis to have been dispensed at least one DMARD. 

o In both urban and rural areas, Black beneficiaries who were diagnosed with rheumatoid 

arthritis were about as likely as White beneficiaries who were diagnosed with rheumatoid 

arthritis to have been dispensed at least one DMARD. 

o Urban Hispanic beneficiaries who were diagnosed with rheumatoid arthritis were more likely 

than urban White beneficiaries who were diagnosed with rheumatoid arthritis to have been 

dispensed at least one DMARD. The difference between urban Hispanic and urban White 

beneficiaries was less than 3 percentage points. Rural Hispanic beneficiaries who were 

diagnosed with rheumatoid arthritis were about as likely as rural White beneficiaries who were 

diagnosed with rheumatoid arthritis to have been dispensed at least one DMARD.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

 

 

 

 
162

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
163

Osteoporosis Management in Women Who Had a Fracture

Percentage of MA enrollees (women) aged 67 to 85 years who suffered a fracture who had either a 

bone mineral density test or a prescription for a drug to treat osteoporosis in the six months after 

the fracture, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low. ‡ There were not enough data from rural API beneficiaries to compare them to White beneficiaries on this 

measure. 

Disparities

o Urban API women who suffered a fracture were more likely than urban White women who 

suffered a fracture to have had either a bone mineral density test or a prescription for a 

drug to treat osteoporosis. The difference between urban API and urban White women was 

greater than 3 percentage points.

o In both urban and rural areas, Black women who suffered a fracture were about as likely as 

White women who suffered a fracture to have had either a bone mineral density test or a 

prescription for a drug to treat osteoporosis.

o In both urban and rural areas, Hispanic women who suffered a fracture were more likely 

than White women who suffered a fracture to have had either a bone mineral density test 

or a prescription for a drug to treat osteoporosis. In each case, the difference between 

Hispanic and White women was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 
164

Clinical Care: Behavioral Health

Antidepressant Medication Management—Acute Phase Treatment

Percentage of MA enrollees aged 18 years and older with a new diagnosis of major depression who 

were newly treated with antidepressant medication and remained on the medication for at least 84 

days, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o In both urban and rural areas, API beneficiaries who were diagnosed with a new episode of 

major depression were less likely than White beneficiaries who were diagnosed with a new 

episode of major depression to have been newly treated with antidepressant medication 

and to have remained on the medication for at least 84 days. In each case, the difference 

between API and White beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, Black beneficiaries who were diagnosed with a new episode of 

major depression were less likely than White beneficiaries who were diagnosed with a new 

episode of major depression to have been newly treated with antidepressant medication 

and to have remained on the medication for at least 84 days. In each case, the difference 

between Black and White beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, Hispanic beneficiaries who were diagnosed with a new 

episode of major depression were less likely than White beneficiaries who were diagnosed 

with a new episode of major depression to have been newly treated with antidepressant 

medication and to have remained on the medication for at least 84 days. In each case, the

difference between Hispanic and White beneficiaries was greater than 3 percentage points.

 

 

 
165

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
166

Antidepressant Medication Management—Continuation Phase Treatment

Percentage of MA enrollees aged 18 years and older with a new diagnosis of major depression who 

were newly treated with antidepressant medication and remained on the medication for at least 180 

days, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries who were diagnosed with a new episode of major depression were 

less likely than urban White beneficiaries who were diagnosed with a new episode of major 

depression to have been newly treated with antidepressant medication and to have remained 

on the medication for at least 180 days. The difference between urban API and urban White 

beneficiaries was greater than 3 percentage points. Rural API beneficiaries who were 

diagnosed with a new episode of major depression were about as likely as rural White 

beneficiaries who were diagnosed with a new episode of major depression to have been

newly treated with antidepressant medication and to have remained on the medication for at 

least 180 days. 

o In both urban and rural areas, Black beneficiaries who were diagnosed with a new episode of 

major depression were less likely than White beneficiaries who were diagnosed with a new 

episode of major depression to have been newly treated with antidepressant medication and 

to have remained on the medication for at least 180 days. In each case, the difference 

between Black and White beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, Hispanic beneficiaries who were diagnosed with a new episode 

of major depression were less likely than White beneficiaries who were diagnosed with a new 

episode of major depression to have been newly treated with antidepressant medication and 

to have remained on the medication for at least 180 days. In each case, the difference 

between Hispanic and White beneficiaries was greater than 3 percentage points.

 

 

 

 
167

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
168

Follow-up After Hospital Stay for Mental Illness

(within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who were hospitalized for treatment of 

selected mental health disorders who had an outpatient visit, an intensive outpatient encounter, or 

partial hospitalization with a mental health practitioner within 30 days of discharge,

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from rural API beneficiaries to compare them to White beneficiaries on this 

measure. 

Disparities

o Urban API beneficiaries who were hospitalized for a mental health disorder were about as

likely as urban White beneficiaries who were hospitalized for a mental health disorder to 

have had a follow-up visit with a mental health practitioner within 30 days of being 

discharged.

o In both urban and rural areas, Black beneficiaries who were hospitalized for a mental 

health disorder were less likely than White beneficiaries who were hospitalized for a 

mental health disorder to have had a follow-up visit with a mental health practitioner 

within 30 days of being discharged. In each case, the difference between Black and White 

beneficiaries was greater than 3 percentage points.

o Urban Hispanic beneficiaries who were hospitalized for a mental health disorder were less 

likely than urban White beneficiaries who were hospitalized for a mental health disorder to 

have had a follow-up visit with a mental health practitioner within 30 days of being 

discharged. The difference between urban Hispanic and urban White beneficiaries was less 

than 3 percentage points. Rural Hispanic beneficiaries who were hospitalized for a mental 

health disorder were more likely than rural White beneficiaries who were hospitalized for a 

 

 
169

mental health disorder to have had a follow-up visit with a mental health practitioner 

within 30 days of being discharged. The difference between rural Hispanic and rural White 

beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Although the lower-bound age cutoff for this HEDIS measure is six years old, the data used in this report are 

limited to adults.
170

Follow-up After Emergency Department (ED) Visit for Mental Illness

(within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who had an ED visit for selected mental health 

disorders who had an outpatient visit, an intensive outpatient encounter, or partial

hospitalization with a mental health practitioner within 30 days of the ED visit, 

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from rural API beneficiaries to compare them to White beneficiaries on this 

measure. 

Disparities

o Urban API beneficiaries who had an ED visit for a mental health disorder were about as

likely as urban White beneficiaries who had an ED visit for a mental health disorder to have 

had a follow-up visit with a mental health practitioner within 30 days of the ED visit. 

o In both urban and rural areas, Black beneficiaries who had an ED visit for a mental health 

disorder were less likely than White beneficiaries who had an ED visit for a mental health 

disorder to have had a follow-up visit with a mental health practitioner within 30 days of 

the ED visit. In each case, the difference between Black and White beneficiaries was 

greater than 3 percentage points.

o Urban Hispanic beneficiaries who had an ED visit for a mental health disorder were less

likely than urban White beneficiaries who had an ED visit for a mental health disorder to 

have had a follow-up visit with a mental health practitioner within 30 days of the ED visit. 

The difference between urban Hispanic and urban White beneficiaries was greater than 3 

percentage points. Rural Hispanic beneficiaries who had an ED visit for a mental health

disorder were about as likely as rural White beneficiaries who had an ED visit for a mental 

 

 
171

health disorder to have had a follow-up visit with a mental health practitioner within 30 

days of the ED visit. 

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Although the lower-bound age cutoff for this HEDIS measure is six years old, the data used in this report are 

limited to adults.
172

Follow-up After Emergency Department (ED) Visit for Alcohol and Other Drug 

(AOD) Abuse or Dependence (within 30 days of discharge)

Percentage of MA enrollees aged 18 years and older† who had an ED visit for AOD abuse or 

dependence who had a follow-up visit for AOD abuse or dependence within 30 days of the ED visit, 

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. ‡ This score is based on fewer than 400 completed measures, and thus its precision may be low. # There were not enough data from rural API beneficiaries to compare them to White beneficiaries on this 

measure.

Disparities

o Urban API beneficiaries who had an ED visit for AOD abuse or dependence were less likely 

than urban White beneficiaries who had an ED visit for AOD abuse or dependence to have 

had a follow-up visit for AOD abuse or dependence within 30 days of the ED visit. The 

difference between urban API and urban White beneficiaries was less than 3 percentage 

points.

o In both urban and rural areas, Black beneficiaries who had an ED visit for AOD abuse or 

dependence were less likely than White beneficiaries who had an ED visit for AOD abuse or 

dependence to have had a follow-up visit for AOD abuse or dependence within 30 days of 

the ED visit. In each case, the difference between Black and White beneficiaries was 

greater than 3 percentage points.

o In both urban and rural areas, Hispanic beneficiaries who had an ED visit for AOD abuse or 

dependence were less likely than White beneficiaries who had an ED visit for AOD abuse or 

dependence to have had a follow-up visit for AOD abuse or dependence within 30 days of 

the ED visit. The difference between urban Hispanic and urban White beneficiaries was less 

 

 

 

 

 
173

than 3 percentage points. The difference between rural Hispanic and rural White 

beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.
174

Initiation of Alcohol and Other Drug Dependence (AOD) Treatment

Percentage of MA enrollees aged 18 years and older† with a new episode of 

AOD dependence who initiate‡ treatment within 14 days of the diagnosis, 

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API beneficiaries with a new episode of AOD dependence were less likely than urban 

White beneficiaries with a new episode of AOD dependence to have initiated treatment 

within 14 days of the diagnosis. The difference between urban API and urban White 

beneficiaries was greater than 3 percentage points. Rural API beneficiaries with a new 

episode of AOD dependence were about as likely as rural White beneficiaries with a new 

episode of AOD dependence to have initiated treatment within 14 days of the diagnosis. 

o Urban Black beneficiaries with a new episode of AOD dependence were more likely than 

urban White beneficiaries with a new episode of AOD dependence to have initiated 

treatment within 14 days of the diagnosis. The difference between urban Black and urban 

White beneficiaries was less than 3 percentage points. Rural Black beneficiaries with a new 

episode of AOD dependence were less likely than rural White beneficiaries with a new 

episode of AOD dependence to have initiated treatment within 14 days of the diagnosis. The 

difference between rural Black and rural White beneficiaries was greater than 3 percentage 

points.

o In both urban and rural areas, Hispanic beneficiaries with a new episode of AOD dependence

were less likely than White beneficiaries with a new episode of AOD dependence to have 

initiated treatment within 14 days of the diagnosis. In each case, the difference between 

Hispanic and White beneficiaries was greater than 3 percentage points.

 

 
175

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.

‡ Initiation may occur through an inpatient AOD admission, outpatient visit, intensive outpatient encounter, or 

partial hospitalization.
176

Engagement of Alcohol and Other Drug Dependence (AOD) Treatment

Percentage of MA enrollees aged 18 years and older† with a new episode of AOD dependence who 

initiated treatment who had two or more AOD services or medication-assisted treatments within 30 

days of the initiation visit, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Urban API beneficiaries with a new episode of AOD dependence who initiated treatment were 

less likely than urban White beneficiaries with a new episode of AOD dependence who 

initiated treatment to have had two or more AOD services or medication-assisted treatments

within 30 days of their initial visit for treatment. The difference between urban API and urban 

White beneficiaries was less than 3 percentage points. Rural API beneficiaries with a new 

episode of AOD dependence who initiated treatment were about as likely as rural White 

beneficiaries with a new episode of AOD dependence who initiated treatment to have had 

two or more AOD services or medication-assisted treatments within 30 days of their initial 

visit for treatment. 

o Urban Black beneficiaries with a new episode of AOD dependence who initiated treatment

were about as likely as urban White beneficiaries with a new episode of AOD dependence 

who initiated treatment to have had two or more AOD services or medication-assisted 

treatments within 30 days of their initial visit for treatment. Rural Black beneficiaries with a 

new episode of AOD dependence who initiated treatment were less likely than rural White 

beneficiaries with a new episode of AOD dependence who initiated treatment to have had 

two or more AOD services or medication-assisted treatments within 30 days of their initial 

visit for treatment. The difference between rural Black and rural White beneficiaries was less

than 3 percentage points.

 

 

 
177

o In both urban and rural areas, Hispanic beneficiaries with a new episode of AOD dependence 

who initiated treatment were less likely than White beneficiaries with a new episode of AOD 

dependence who initiated treatment to have had two or more AOD services or medicationassisted treatments within 30 days of their initial visit for treatment. The difference between 

urban Hispanic and urban White beneficiaries was less than 3 percentage points. The 

difference between rural Hispanic and rural White beneficiaries was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Although the lower-bound age cutoff for this HEDIS measure is 13 years old, the data used in this report are 

limited to adults.
178

Clinical Care: Medication Management and Care Coordination

Medication Reconciliation After Hospital Discharge

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

who had their medications reconciled within 30 days, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries who were discharged from an inpatient facility were less likely than 

urban White beneficiaries who were discharged from an inpatient facility to have had their 

medications reconciled within 30 days. The difference between urban API and urban White 

beneficiaries was greater than 3 percentage points. Rural API beneficiaries who were 

discharged from an inpatient facility were about as likely as rural White beneficiaries who 

were discharged from an inpatient facility to have had their medications reconciled within 30 

days. 

o Urban Black beneficiaries who were discharged from an inpatient facility were less likely than 

urban White beneficiaries who were discharged from an inpatient facility to have had their 

medications reconciled within 30 days. The difference between urban Black and urban White 

beneficiaries was greater than 3 percentage points. Rural Black beneficiaries who were 

discharged from an inpatient facility were about as likely as rural White beneficiaries who 

were discharged from an inpatient facility to have had their medications reconciled within 30 

days. 

o In both urban and rural areas, Hispanic beneficiaries who were discharged from an inpatient 

facility were less likely than White beneficiaries who were discharged from an inpatient 

 

 

 
179

facility to have had their medications reconciled within 30 days. The difference between 

urban Hispanic and urban White beneficiaries was less than 3 percentage points. The 

difference between rural Hispanic and rural White beneficiaries was greater than 3 

percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
180

Transitions of Care—Notification of Inpatient Admission

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

whose primary or ongoing care providers were notified of the inpatient admission on the day of or 

the day following admission, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o In both urban and rural areas, the primary or ongoing care providers of API beneficiaries who 

were discharged from an inpatient facility were about as likely as the primary or ongoing care 

providers of White beneficiaries who were discharged from an inpatient facility to have been 

notified of the inpatient admission on the day of or the day following admission. 

o In both urban and rural areas, the primary or ongoing care providers of Black beneficiaries 

who were discharged from an inpatient facility were less likely than the primary or ongoing 

care providers of White beneficiaries who were discharged from an inpatient facility to have 

been notified of the inpatient admission on the day of or the day following admission. In 

each case, the difference between these groups was greater than 3 percentage points.

o In both urban and rural areas, the primary or ongoing care providers of Hispanic beneficiaries 

who were discharged from an inpatient facility were less likely than the primary or ongoing 

care providers of White beneficiaries who were discharged from an inpatient facility to have 

been notified of the inpatient admission on the day of or the day following admission. In 

each case, the difference between these groups was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 

 
181

Transitions of Care—Receipt of Discharge Information

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility 

who received discharge information on the day of or the day following discharge, 

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries who were discharged from an inpatient facility were more likely than

urban White beneficiaries who were discharged from an inpatient facility to have received 

discharge information on the day of or the day following discharge. The difference between 

urban API and urban White beneficiaries was less than 3 percentage points. Rural API 

beneficiaries who were discharged from an inpatient facility were about as likely as rural 

White beneficiaries who were discharged from an inpatient facility to have received 

discharge information on the day of or the day following discharge. 

o In both urban and rural areas, Black beneficiaries who were discharged from an inpatient 

facility were less likely than White beneficiaries who were discharged from an inpatient 

facility to have received discharge information on the day of or the day following discharge. 

In each case, the difference between Black and White beneficiaries was greater than 3 

percentage points.

o In both urban and rural areas, Hispanic beneficiaries who were discharged from an inpatient 

facility were less likely than White beneficiaries who were discharged from an inpatient 

facility to have received discharge information on the day of or the day following discharge. 

In each case, the difference between Hispanic and White beneficiaries was greater than 3 

percentage points.

 

 

 

 

 
182

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
183

Transitions of Care—Patient Engagement After Inpatient Discharge

Percentage of MA enrollees aged 18 years and older who were discharged from an inpatient facility for 

whom patient engagement (office visit, home visit, telehealth) was provided within 30 days of 

discharge, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries. † This score is based on fewer than 400 completed measures, and thus its precision may be low.

Disparities

o Urban API beneficiaries who were discharged from an inpatient facility were more likely than

urban White beneficiaries who were discharged from an inpatient facility to have had an office 

visit, to have had a home visit, or to have received telehealth services within 30 days of 

discharge. The difference between urban API and urban White beneficiaries was less than 3 

percentage points. Rural API beneficiaries who were discharged from an inpatient facility were 

about as likely as rural White beneficiaries who were discharged from an inpatient facility to 

have had an office visit, to have had a home visit, or to have received telehealth services 

within 30 days of discharge. 

o Urban Black beneficiaries who were discharged from an inpatient facility were less likely than 

urban White beneficiaries who were discharged from an inpatient facility to have had an office 

visit, to have had a home visit, or to have received telehealth services within 30 days of 

discharge. The difference between urban Black and urban White beneficiaries was less than 3 

percentage points. Rural Black beneficiaries who were discharged from an inpatient facility 

were about as likely as rural White beneficiaries who were discharged from an inpatient facility 

to have had an office visit, to have had a home visit, or to have received telehealth services 

within 30 days of discharge. 

o Urban Hispanic beneficiaries who were discharged from an inpatient facility were more likely 

than urban White beneficiaries who were discharged from an inpatient facility to have had an 

office visit, to have had a home visit, or to have received telehealth services within 30 days of 

 

 

 

 

 
184

discharge. The difference between urban Hispanic and urban White beneficiaries was less than 

3 percentage points. Rural Hispanic beneficiaries who were discharged from an inpatient 

facility were less likely than rural White beneficiaries who were discharged from an inpatient 

facility to have had an office visit, to have had a home visit, or to have received telehealth 

services within 30 days of discharge. The difference between rural Hispanic and rural White 

beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
185

Follow-up After Emergency Department (ED) Visit for People with High-Risk 

Multiple Chronic Conditions

Percentage of MA enrollees aged 18 years and older with multiple high-risk chronic conditions† who 

received follow-up care within seven days of an ED visit, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, API beneficiaries with multiple high-risk chronic conditions were 

about as likely as White beneficiaries with multiple high-risk chronic conditions to have 

received follow-up care within seven days of an ED visit. 

o In both urban and rural areas, Black beneficiaries with multiple high-risk chronic conditions

were less likely than White beneficiaries with multiple high-risk chronic conditions to have 

received follow-up care within seven days of an ED visit. The difference between urban Black 

and urban White beneficiaries was greater than 3 percentage points. The difference between 

rural Black and rural White beneficiaries was less than 3 percentage points.

o In both urban and rural areas, Hispanic beneficiaries with multiple high-risk chronic conditions 

were less likely than White beneficiaries with multiple high-risk chronic conditions to have 

received follow-up care within seven days of an ED visit. The difference between urban 

Hispanic and urban White beneficiaries was less than 3 percentage points. The difference 

between rural Hispanic and rural White beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 

 
186

† Conditions include COPD and asthma, Alzheimer’s disease and related disorders, chronic kidney disease, 

depression, heart failure, acute myocardial infarction, atrial fibrillation, and stroke and transient ischemic attack.
187

Clinical Care: Overuse/Appropriateness

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with Chronic Renal Failure

Percentage of MA enrollees aged 65 years and older with chronic renal failure who were not 

dispensed a prescription for a potentially harmful medication,† by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of potentially harmful medication was avoided less often for elderly urban API 

beneficiaries with chronic renal failure than for elderly urban White beneficiaries with chronic 

renal failure. The difference between elderly urban API and elderly urban White beneficiaries 

was less than 3 percentage points. Use of potentially harmful medication was avoided about 

as often for elderly rural API beneficiaries with chronic renal failure as for elderly rural White 

beneficiaries with chronic renal failure. 

o In both urban and rural areas, use of potentially harmful medication was avoided less often 

for elderly Black beneficiaries with chronic renal failure than for elderly White beneficiaries 

with chronic renal failure. In each case, the difference between elderly Black and elderly 

White beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, use of potentially harmful medication was avoided less often 

for elderly Hispanic beneficiaries with chronic renal failure than for elderly White 

beneficiaries with chronic renal failure. In each case, the difference between elderly Hispanic

and elderly White beneficiaries was greater than 3 percentage points.

 

 

 
188

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) and nonaspirin NSAIDs.
189

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with Dementia

Percentage of MA enrollees aged 65 years and older with dementia who were not dispensed a 

prescription for a potentially harmful medication,† by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, use of potentially harmful medication was avoided more often 

for elderly API beneficiaries with dementia than for elderly White beneficiaries with dementia. 

In each case, the difference between elderly API and elderly White beneficiaries was greater

than 3 percentage points. 

o In both urban and rural areas, use of potentially harmful medication was avoided more often 

for elderly Black beneficiaries with dementia than for elderly White beneficiaries with 

dementia. The difference between elderly urban Black and elderly urban White beneficiaries 

was greater than 3 percentage points. The difference between elderly rural Black and elderly 

rural White beneficiaries was less than 3 percentage points.

o In both urban and rural areas, use of potentially harmful medication was avoided less often for 

elderly Hispanic beneficiaries with dementia than for elderly White beneficiaries with 

dementia. In each case, the difference between elderly Hispanic and elderly White 

beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 
190

† This includes antiemetics, antipsychotics, benzodiazepines, tricyclic antidepressants, H2 receptor antagonists, 

nonbenzodiazepine hypnotics, and anticholinergic agents.
191

Avoiding Potentially Harmful Drug-Disease Interactions

in Elderly Patients with a History of Falls

Percentage of MA enrollees aged 65 years and older with a history of falls who were not dispensed a 

prescription for a potentially harmful medication,† by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, use of potentially harmful medication was avoided more often 

for elderly API beneficiaries with a history of falls than for elderly White beneficiaries with a 

history of falls. In each case, the difference between elderly API and elderly White 

beneficiaries was greater than 3 percentage points.

o In both urban and rural areas, use of potentially harmful medication was avoided more often 

for elderly Black beneficiaries with a history of falls than for elderly White beneficiaries with a 

history of falls. In each case, the difference between elderly Black and elderly White 

beneficiaries was greater than 3 percentage points.

o Use of potentially harmful medication was avoided more often for elderly urban Hispanic 

beneficiaries with a history of falls than for elderly urban White beneficiaries with a history of 

falls. The difference between elderly urban Hispanic and elderly urban White beneficiaries was 

less than 3 percentage points. Use of potentially harmful medication was avoided less often 

for elderly rural Hispanic beneficiaries with a history of falls than for elderly rural White 

beneficiaries with a history of falls. The difference between elderly rural Hispanic and elderly 

rural White beneficiaries was greater than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

 

 
192

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† This includes anticonvulsants, nonbenzodiazepine hypnotics, selective serotonin reuptake inhibitors, antiemetics, 

antipsychotics, benzodiazepines, and tricyclic antidepressants.
193

Avoiding Use of High-Risk Medications in the Elderly

Percentage of MA enrollees aged 65 years and older who were not prescribed a high-risk medication, 

by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, use of high-risk medication was avoided more often for elderly 

API beneficiaries than for elderly White beneficiaries. In each case, the difference between 

elderly API and elderly White beneficiaries was greater than 3 percentage points.

o Use of high-risk medication was avoided more often for elderly urban Black beneficiaries than 

for elderly urban White beneficiaries. The difference between elderly urban Black and elderly 

urban White beneficiaries was less than 3 percentage points. Use of high-risk medication was 

avoided less often for elderly rural Black beneficiaries than for elderly rural White 

beneficiaries. The difference between elderly rural Black and elderly rural White beneficiaries 

was less than 3 percentage points.

o In both urban and rural areas, use of high-risk medication was avoided more often for elderly

Hispanic beneficiaries than for elderly White beneficiaries. In each case, the difference 

between elderly Hispanic and elderly White beneficiaries was less than 3 percentage points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

  

 
194

Avoiding Use of Opioids at High Dosage

Percentage of MA enrollees aged 18 years and older who were not prescribed opioids at a high dosage†

for more than 14 days, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, use of opioids at a high dosage for more than 14 days was

avoided more often for API beneficiaries than for White beneficiaries. The difference between 

urban API and urban White beneficiaries was greater than 3 percentage points. The difference 

between rural API and rural White beneficiaries was less than 3 percentage points.

o In both urban and rural areas, use of opioids at a high dosage for more than 14 days was 

avoided more often for Black beneficiaries than for White beneficiaries. In each case, the

difference between Black and White beneficiaries was less than 3 percentage points.

o In both urban and rural areas, use of opioids at a high dosage for more than 14 days was 

avoided more often for Hispanic beneficiaries than for White beneficiaries. The difference 

between urban Hispanic and urban White beneficiaries was less than 3 percentage points. The 

difference between rural Hispanic and rural White beneficiaries was greater than 3 percentage 

points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

† Average morphine equivalent dose > 120 mg.

 

 

 

 

 
195

Avoiding Use of Opioids from Multiple Prescribers

Percentage of MA enrollees aged 18 years and older who did not receive prescriptions for opioids from 

four or more prescribers in the past year, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of opioids from multiple prescribers was avoided more often for urban API beneficiaries 

than for urban White beneficiaries. The difference between urban API and urban White 

beneficiaries was less than 3 percentage points. Use of opioids from multiple prescribers was 

avoided about as often for rural API beneficiaries as for rural White beneficiaries.

o In both urban and rural areas, use of opioids from multiple prescribers was avoided less often 

for Black beneficiaries than for White beneficiaries. In each case, the difference between Black 

and White beneficiaries was less than 3 percentage points.

o Use of opioids from multiple prescribers was avoided less often for urban Hispanic 

beneficiaries than for urban White beneficiaries. The difference between urban Hispanic and 

urban White beneficiaries was less than 3 percentage points. Use of opioids from multiple 

prescribers was avoided more often for rural Hispanic beneficiaries than for rural White 

beneficiaries. The difference between rural Hispanic and rural White beneficiaries was greater 

than 3 percentage points. _____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 

 
196

Avoiding Use of Opioids from Multiple Pharmacies

Percentage of MA enrollees aged 18 years and older who did not receive prescriptions for opioids from 

four or more pharmacies in the past year, by race and ethnicity

within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o Use of opioids from multiple pharmacies was avoided more often for urban API beneficiaries 

than for urban White beneficiaries. The difference between urban API and urban White 

beneficiaries was less than 3 percentage points. Use of opioids from multiple pharmacies was 

avoided about as often for rural API beneficiaries as for rural White beneficiaries.

o Use of opioids from multiple pharmacies was avoided less often for urban Black beneficiaries 

than for urban White beneficiaries. The difference between urban Black and urban White 

beneficiaries was less than 3 percentage points. Use of opioids from multiple pharmacies was 

avoided about as often for rural Black beneficiaries as for rural White beneficiaries.

o In both urban and rural areas, use of opioids from multiple pharmacies was avoided less often 

for Hispanic beneficiaries than for White beneficiaries. The difference between urban Hispanic 

and urban White beneficiaries was less than 3 percentage points. The difference between rural 

Hispanic and rural White beneficiaries was greater than 3 percentage points. _____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.

 

 

 

 

 
197

Clinical Care: Access/Availability of Care

Older Adults’ Access to Preventive/Ambulatory Services

Percentage of MA enrollees aged 65 years and older who had an ambulatory or preventive care visit in 

the past year, by race and ethnicity within urban and rural areas, 2019

 

SOURCE: Clinical quality data collected in 2019 from Medicare health plans nationwide. 

NOTES: API = Asian or Pacific Islander. Racial groups such as Black and White are non-Hispanic; Hispanic 

ethnicity includes all races. Clinical quality data are not available for Medicare FFS beneficiaries.

Disparities

o In both urban and rural areas, API beneficiaries were less likely than White beneficiaries to 

have had an ambulatory or preventive care visit. In each case, the difference between API and 

White beneficiaries was less than 3 percentage points.

o Urban Black beneficiaries were less likely than urban White beneficiaries to have had an 

ambulatory or preventive care visit. The difference between urban Black and urban White 

beneficiaries was less than 3 percentage points. Rural Black beneficiaries were more likely than 

rural White beneficiaries to have had an ambulatory or preventive care visit. The difference 

between rural Black and rural White beneficiaries was less than 3 percentage points.

o Urban Hispanic beneficiaries were less likely than urban White beneficiaries to have had an 

ambulatory or preventive care visit. The difference between urban Hispanic and urban White 

beneficiaries was less than 3 percentage points. Rural Hispanic beneficiaries were more likely 

than rural White beneficiaries to have had an ambulatory or preventive care visit. The 

difference between rural Hispanic and rural White beneficiaries was less than 3 percentage 

points.

_____________________________________

* Significantly different from the score for White residents of the same locality (p < 0.05).

 

 

 

 

 
198

For statistically significant differences between White beneficiaries and racial or ethnic minorities of the same 

locality, the following symbols are also used when applicable:

(+) Difference is ≥ 3 points (prior to rounding) and favors the racial or ethnic minority group.

(-) Difference is ≥ 3 points (prior to rounding) and favors White beneficiaries.
199

Appendix: Data Sources and Methods 

The Medicare Consumer Assessment of Healthcare Providers and Systems Surveys

The Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey consists of a 

set of mail surveys with telephone follow-ups based on a stratified random sample of Medicare 

beneficiaries, with contracts serving as strata for Medicare Advantage (MA) beneficiaries and for fee-forservice (FFS) beneficiaries enrolled in prescription drug plans (PDPs) and states serving as strata for FFS 

beneficiaries not enrolled in a PDP. The 2019 survey attempted to contact 874,398 Medicare 

beneficiaries and received responses from 318,116, a 36.4 percent response rate. The 2019 survey 

represents all FFS beneficiaries, MA beneficiaries from 449 MA contracts that either were required to 

report (minimum of 600 eligible enrollees) or reported voluntarily (450–599 enrollees), and PDP 

beneficiaries from 53 PDP contracts with at least 1,500 eligible enrollees.

The Healthcare Effectiveness Data and Information Set

The Healthcare Effectiveness Data and Information Set (HEDIS) consists of more than 90 measures 

across six domains of care (National Committee for Quality Assurance [NCQA], 2020). These domains 

include effectiveness of care, access/availability of care, experience of care, utilization and risk-adjusted 

utilization, relative resource use, and health plan descriptive information. HEDIS measures are 

developed, tested, and validated under the direction of NCQA. Although CAHPS data are collected only 

via surveys, HEDIS data are gathered both via surveys and via medical charts and insurance claims for 

hospitalizations, medical office visits, and procedures. In selecting HEDIS measures to include in this 

report, we excluded measures that underwent a recent change in specification, were similar to reported 

measures preferred by the Centers for Medicare & Medicaid Services (CMS), or were deemed unsuitable 

for this application by CMS experts. HEDIS data are available only for MA beneficiaries.

Information on Geography

Beneficiaries were classified as living in a rural or urban area based on the zip code of their mailing 

address and the corresponding Census Bureau core-based statistical area (CBSA). CBSAs consist of the 

county or counties or equivalent entities associated with at least one core urban area plus adjacent 

counties having a high degree of social and economic integration with the core as measured through 

commuting ties with the counties that make up the core. Metropolitan statistical areas contain a core 

urban area with a population of 50,000 or more. Micropolitan statistical areas contain a core urban area 

with a population of at least 10,000 but less than 50,000. For this report, any beneficiary residing within 

a metropolitan statistical area was classified as an urban resident; any beneficiary living in a 

micropolitan statistical area or outside of a CBSA was classified as a rural resident.

Information on Race and Ethnicity

The 2019 CAHPS survey asked beneficiaries, “Are you of Hispanic or Latino origin or descent?” The 

response options were: “Yes, Hispanic or Latino” and “No, not Hispanic or Latino.” The survey then 

asked, “What is your race? Please mark one or more,” with response options of “White,” “Black or 

African American,” “Asian,” “Native Hawaiian or other Pacific Islander,” and “American Indian or Alaska 

Native.” Following a U.S. Census approach, answers to these two questions were used to classify 

respondents into one of seven mutually exclusive categories: Hispanic, multiracial, American 

Indian/Alaska Native (AI/AN), Asian/Pacific Islander (API), Black, White, or unknown.

• Respondents who endorsed Hispanic ethnicity were classified as Hispanic regardless of races 

endorsed.
200

• Non-Hispanic respondents who endorsed two or more races were classified as multiracial, with 

a single exception: Those who selected both “Asian” and “Native Hawaiian or other Pacific 

Islander” but no other race were classified as API.

• Non-Hispanic respondents who selected exactly one race were classified as AI/AN, API, Black, or 

White, according to their responses.

• Respondents without data regarding race/ethnicity were classified as unknown.

• Unknown cases were dropped from the analysis. The multiracial group was included in the 

analysis, but estimates for this group are not presented in this report.

HEDIS data, unlike CAHPS data, do not contain the patient’s self-reported race and ethnicity. Therefore, 

we imputed race and ethnicity for the HEDIS data using a methodology that combines information from 

administrative data, surname, and residential location (Haas et al., 2019). This methodology is 

recommended for estimating racial and ethnic disparities for Black, Hispanic, API, and White 

beneficiaries, but not for AI/AN or multiracial beneficiaries. In 2019, there were 529 MA contracts that 

supplied the 18,870,141 HEDIS measure records used.

Comparisons of rural-urban differences in patient experience by racial and ethnic group and racial and 

ethnic differences in patient experience by geography focus on AI/AN, API, Black, Hispanic, and White 

beneficiaries. Comparisons of rural-urban differences in clinical care by racial and ethnic group and racial 

and ethnic differences in clinical care by geography focus on API, Black, Hispanic, and White 

beneficiaries. Estimates of clinical care delivered to AI/AN beneficiaries were excluded for the reason 

noted above.

Analytic Approach

The CAHPS measures presented in this report are composite measures that summarize, through 

averaging, the answers to two or more related CAHPS survey questions, or items. The annual flu vaccine 

measure is included in the CAHPS survey and is thus grouped with other CAHPS measures in this report. 

It is, however, considered to be a HEDIS measure. This is a single-item measure rather than a composite.

CAHPS estimates for rural and urban residents are from case-mix adjusted linear regression models that 

contained health contract intercepts, an indicator of rural residence (urban was the reference group), 

and the following case-mix adjustors: age, education, self-rated health and mental health, dual 

eligibility/low-income subsidy, and proxy status. No adjustment was made for survey language. CAHPS 

estimates for rural and urban residents of different racial and ethnic backgrounds are from case-mix 

adjusted linear regression models stratified by racial and ethnic group. These models contained health 

contract intercepts, an indicator of rural residence, and the same set of case-mix adjustors used in the 

overall rural-urban models.

Predicted probabilities of race and ethnicity were used as weights to develop HEDIS-measure estimates 

for racial and ethnic subgroups (Elliott et al., 2009). None of the HEDIS measures reported (including the 

annual flu vaccine measure) is case-mix adjusted.

Cases with missing data on outcome measures were excluded from the analysis. There were no missing 

data on predictors (race and ethnicity and rural/urban residence) included in the analyses of HEDIS 

measures. For analyses of CAHPS measures, cases with missing information on race/ethnicity (about 4

percent) were excluded from the analysis, and missing data on case-mix adjustors were imputed using 

the health contract mean. There were no missing data on rural/urban residence. 

Statistical significance tests were used to compare the model-estimated scores for rural residents with 

the score for urban residents and to compare model-estimated scores for racial and ethnic minority 

groups with scores for White beneficiaries. A difference in scores is denoted as statistically significant if 

there is less than a 5-percent chance that the difference could have resulted due to sampling error 

alone. Differences that are statistically significant and larger than 3 points on a 0–100 scale (CAHPS) or 3 
201

percentage points (HEDIS) are further denoted as practically significant. That is, in the charts that 

present national data on rural-urban differences in patient experience (CAHPS) and clinical care (HEDIS), 

differences that are not statistically significant or are statistically significant but less than 3 points in 

magnitude are distinguished (using symbols and labeling) from differences that are both statistically 

significant and 3 points in magnitude or larger. The 3-point criterion was selected because a difference

of this size is considered to be of moderate magnitude (Paddison et al., 2013).
202

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Paddison, Charlotte A., Marc N. Elliott, Amelia M. Haviland, Donna O. Farley, Georgios Lyratzopoulos,

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Disclaimer

Paid for by the US Department of Health and Human Services

Suggested Citation

Martino, SC, Elliott, MN, Dembosky, JW, Hambarsoomian, K, Klein, DJ, Gildner, J, and Haviland, AM. 

Rural-Urban Disparities in Health Care in Medicare. Baltimore, MD: CMS Office of Minority Health. 2020.