OBJECTIVES. Prior research documents persistent gender gaps in cardiovascular risk management, with women receiving poorer-quality routine care on average, even in managed care systems. Improvements in population health management tools and quality improvement (QI) efforts have led to better quality of care overall and narrowing of racial/ethnic gaps for a variety of measures. It remains unclear to what extent gender gaps in cardiovascular risk management persist and how well routinely-used population health management tools perform in helping systems narrow gender gaps.

METHODS. Using 2013-2014 claims and enrollment data from over a million members of a large, national health insurance plan, we assessed performance on 7 evidence-based quality measures for management of coronary artery disease (CAD) and diabetes (DM), a cardiac risk factor, among 27,918 individuals with CAD (9,604 women and 18,314 men), and 78,529 individuals with DM (38,525 women and 40,004 men), from four metropolitan areas.

RESULTS. Low-density lipoprotein cholesterol control rates (LDL<100) were 5 and 15 percentage points lower for women than men with DM (p<.0001), and CAD (p<.0001), respectively. Women with CAD faced higher odds than men of not achieving LDL<100 (odds ratio [OR]=1.85, 95% confidence interval [CI]=1.65-2.08), and of not achieving LDL<100 or being on a moderate-dose statin (OR=2.18, 95% CI=1.90-2.51). Gender gaps observed were not associated with geographic variation, case mix severity, or eligibility for population health management programs.

CONCLUSIONS. Given our findings that gender gaps persist across both clinical and geographic variation, we identified additional steps health plans can take to reduce disparities. For measures where gaps have been consistently identified, we recommend that gender-stratified quality reporting and analysis be used to complement widely-used algorithms. This additional step will help health plans identify individuals with unmet needs at risk for CAD, so they can be referred to disease management and wellness behavior support programs.