By Chris M. Lester

Our research team explores the relationship between preventive services receipt and economic distress. The findings explain why our future tools will incorporate regional social determinants of health measures

Community-level social determinants of health and economic distress explain some differences in health service utilization and disparities in health outcomes among Americans broadly, and perhaps especially among Medicare enrollees due to their age or disability status. For organizations working to improve the quality and reduce the cost of healthcare for their populations, awareness of these factors can be used to tailor approaches to distinct needs of population subsets.

Through partnerships with researchers at Microsoft Health NEXT, CareJourney is exploring disparities in care access, utilization and outcomes across the country and for vulnerable populations using CareJourney’s access to full national Medicare claims sample. Recently, members of the CareJourney and Microsoft collaborative team published an article in The Journal of General Internal Medicine, “Association Between Community Economic Distress and receipt of Recommended Services among Medicare Fee-for-Service Enrollees.”


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Analyzing Distressed Community Index (DCI) scores by zip code

From the Economic Innovation Group (EIG) ( we obtained ZIP Code level 2017 Distressed Community Index (DCI) scores-an aggregation of seven ZIP Code specific economic measures including: local mean income, employment rates, educational attainment, poverty rates, and unoccupied habitable housing rates. Based on the DCI scores we assigned each ZIP-Code a quintile ranging from lowest to highest economic distress.

We identified US-residing beneficiaries continuously enrolled in FFS Medicare Parts A and B in2017. For each ZIP Code level, we calculated the number of Medicare beneficiaries, annual per-capita Medicare Part A and B expenditures, mean hierarchical condition category (HCC) score, and the proportion of patients who received each of three preventive care services: flu vaccines, Advance Care Planning (ACP) and Annual Wellness Visits (AWV). We measured Transitional Care Management (TCM) service receipt among those eligible for TCM. We then matched these measurements to the ZIP Code category (quintile) of DCI scores to understand how receipt of these recommended services correlated with economic distress.

The Correlation Between Economic Distress and Preventive Care

Our research found that generally, beneficiaries in areas of greater economic distress receive significantly less recommended and preventive care services than those in less distressed communities. This study suggests that available measures of economic distress could be used to inform care management and outreach resource allocation aimed at improving receipt of services believed effective in improving health outcomes.

We’ve included table 1 from the study below.

Distressed Community Index Score Quintile
Least 2 3 4 Most
Mean Per Capita Expenditures ($) 9,885 10,044 10,435 10,758 11,385
Flu shots (%) 50.6 44.4 40.4 37.1 33.4
Annual wellness visits (%) 29.9 25.1 22.2 19.6 18.3
Transitional care management (%) 14.8 15.7 14.5 13.3 11.6
Advanced care planning visits (%) 3.37 3.85 3.86 4.09 4.45

CareJourney and our collaborators will continue with more in depth research into how disparities in health might be understood and addressed. In future product releases, CareJourney’s tools will incorporate available social determinants of health data to help our clients better segment beneficiaries and evaluate care access issues for their vulnerable populations.

To access the full research report, go here.


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