While most physicians agree they are in a position to make a difference in minority health care, professional societies may need to help ease the burden of the growing barriers that affect prescribing and use of innovative cardiovascular therapies, according to survey results from the ACC and the Association of Black Cardiologists (ABC).

The survey looked at 159 active physician members of the ACC and ABC who practice in higher-poverty areas, and ran from Jan. 23 – Feb. 16, 2018. Results show that 42 percent of cardiovascular clinicians find it difficult to get access to new pharmacologic therapies for patients from health plans and pharmacy benefit managers, with the most prevalent barriers being cost issues (78 percent) and prior authorization documentation/administrative burden (75 percent). Additionally, 43 percent of physicians say they do not have sufficient employee resources to properly manage prior authorization documentation, submissions and appeals.

The survey also highlights concerns that minority patients are less likely to get new therapies (73 percent) and are more likely to receive lower quality care (71 percent). Disparities in care (75 percent) tops the list of formulary restrictions that impact patients, followed by patient confusion and lack of understanding and medication discontinuation.

That being said, several survey participants note that socioeconomic factors like education, income and whether patients lived in urban or rural areas played greater roles in patient access than racial disparities. "In my experience, gender and socioeconomic disparities supersede racial disparities when it comes to quality of care," said one survey participant. "Wealthy, highly-educated professionals receive better quality care, irrespective of race. Similarly, poor, uneducated, unemployed, socially-marginalized patients receive worse quality of care, irrespective of race."

When it comes to solutions, the majority of survey respondents (79 percent) believe they are in a position to help make a difference in minority health care. Among the suggestions, educating trainees during their medical school residency about the barriers and biases in receiving adequate or appropriate health care. Patient choice and education is also a major factor. "In my experience, a higher proportion of minority patients are not willing to pay higher copays, participate in research or participate in preauthorization processes such as company financial aid processes," explains another survey participant. "[Many] are not trusting and invested in health care, which is a significant barrier and cause of disparity."

To help ease the burden of insurance denials, the survey also shows that cardiovascular professionals want societies like the ACC and ABC to help with tools and resources that decrease the prior authorization burden. Recently the ACC announced a new initiative that leverages prospective clinical registry data and partnerships spanning the pharmaceutical and medical device industry, health plans, employers, clinicians and patients to reduce the administrative burden associated with ensuring the most vulnerable heart disease patients have access to medications that can save their lives. Several prior authorization reporting tools (PART) are also available to help inform where and how often imaging and drug-related denials are occurring.

One participant concludes that "it boils down to money – are insurers willing to cover the more expensive procedure and do the patients have the means to cover the costs/copays?" "Whatever the ACC and ABC can do to change these variables in favor of the patients … I wholeheartedly support."

Clinical Topics: Cardiovascular Care Team

Keywords: Minority Health, Insurance Carriers, Internship and Residency, Poverty Areas, Minority Groups, Socioeconomic Factors, Income, Surveys and Questionnaires, Registries, Documentation, Heart Diseases

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