Majority of Those in Medicare Advantage Not Enrolled
in Top Ranked Plans
Only 0.3% of MA enrollees are in a ‘5’ star, or
top-rated, plan; starting in 2012, plans’ payments will be tied to their
scores
Medicare
Advantage
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April 29, 2010 - The majority of people in the
Medicare Advantage (MA) program are currently not enrolled in the
highest-quality plans, despite the existence of a star rating system
that assesses quality for MA plans, says a new analysis released by
Avalere Health.
The star rating system is run by the Centers for
Medicare and Medicaid Services (CMS), and was put in place as part of an
effort to help educate consumers on quality and make quality data more
transparent. Its summary ratings are based on five major domains:
● staying healthy via preventive services such as screenings and
vaccines;
● managing chronic conditions;
● ratings of plan responsiveness and care;
● complaints, appeals, and voluntary disenrollment; and
● telephone customer service.
Avalere analyzed the CMS 2010 Part C Report Card,
released in November 2009, and enrollment data released in April 2010 to
see whether beneficiaries’ plan selections correspond with 5-star
quality ratings assigned by the government.
According to Avalere’s analysis, 47.2% of MA
enrollees are in plans with a ‘3’ or below rating, while 38.7% are in
plans rated ‘3.5’ and up.
Only 0.3% of MA enrollees are in a ‘5’ star, or
top-rated, plan.
Another 14.1% are unaccounted for, due to a plan being
too new to measure or having insufficient data to calculate the contract
score.
Currently star rating scores are assessed and
routinely published on CMS’s website and Plan Finder, a web tool
designed to help beneficiaries select MA plans. The scores will
continue to be published annually.
Coming with Health Care Reform
However, new starting in 2012, plans’ payments will
be tied to their scores. Plans receiving 4 or more stars will be
eligible for quality bonuses of up to 5 percent of local fee-for-service
costs when fully phased in; higher-rated plans will also be able to keep
a larger percentage of the rebate dollars plans use to reduce
beneficiaries’ cost sharing and enhance benefits.
Together, these incentives may blunt some of the
estimated $200 billion in cuts to MA plan payments for the
highest-quality plans, and may prompt shifts in enrollment as plan
benefit designs become increasingly reliant on their performance.
“The government clearly intends to use the star
rating program more aggressively to reward plans focused on quality and
weed out those that are not meeting certain measures,” said Bonnie
Washington, a vice president at Avalere Health.
“Many plans are likely to be focused on improving
their scores as payment becomes increasingly tied to quality. In the
short term, that may mean more attention on dealing with complaints or
their customer service. Long-term, we’ll likely see more focus in areas
such as outcomes, improving beneficiary experience, and disease
management, which may ultimately benefit consumers.”
Information Source:
Avalere Health is an advisory services company
whose core purpose is to create innovative solutions to complex
healthcare problems. Based in Washington DC, the firm delivers research,
analysis, insight, and strategy for leaders in healthcare business and
policy. Avalere's experts span 125 staff drawn from the federal
government (e.g., CMS, OMB, CBO, and the Congress), Fortune 500
healthcare companies, top consultancies, and nonprofits. The firm offers
deep substance in areas ranging from healthcare coverage and financing
to the changing role of evidence in healthcare decision-making. Its
focus on strategy is supported by a rigorous, in-house analytic research
group that uses public and private data to generate quantitative
insight. Through events, publications, and interactive programs, Avalere
also translates real-time healthcare developments into actionable
information.
Bill passed with help of only three Republicans,
signed by President last night