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Cooke CE, Olshanskaya S, Lee M, Brandt NJ. Evolution of the Comprehensive Medication Review Completion Rate for Medicare Part D Plans: What Do the Stars Tell Us? Sr Care Pharm 2022; 37:357-365. [PMID: 35879850 DOI: 10.4140/tcp.n.2022.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective To describe changes in the Medicare Part D Comprehensive Medication Review (CMR) completion rate within the Centers for Medicare & Medicaid Services (CMS) Star Ratings program since its inception. Methods Publicly available information for Star Ratings years 2014 to 2021 was obtained from the CMS website and through indexed literature and internet searches. Data elements for the CMR completion measure were extracted for Medicare Advantage prescription drug plans (MA-PDs) and prescription drug plans (PDPs) and included the annual weighted value, cut-points for star rating, completion rates, and star achievement. Results In 2014 and 2015, the CMR completion rate was a display measure in the Star Ratings program with rates between 10 and 16%. This measure was added in 2016 with a weighted value of 1 that has remained the same. The cut-points when comparing 2016 with 2021 have increased from less than 13.6 to less than 48% for 1 star and 76 to 89% or more for 5 stars for MA-PDs and from less than 8.5 to less than 24% for 1 star and 36.7 to 61% or more for 5 stars for PDPs. From 2016 to 2021, the average Star Ratings for CMR completion increased from 2.3 to 3.7 for MA-PDs and 2.3 to 3.6 for PDPs. Conclusion Since the inception of the CMR completion rate as a quality measure, an increasing proportion of eligible beneficiaries has received a CMR with MA-PDs consistently providing this service to more beneficiaries than PDPs. The cut-points for star achievement have also risen, requiring higher CMR completion rates to achieve higher star ratings. Further evolution of the CMR quality measure is needed for improving medication management.
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Affiliation(s)
| | | | - Merton Lee
- University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Nicole J Brandt
- University of Maryland School of Pharmacy, Baltimore, Maryland
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2
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DuGoff E, Chao S. What's Driving High Disenrollment in Medicare Advantage? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019841506. [PMID: 30983463 PMCID: PMC6466458 DOI: 10.1177/0046958019841506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disenrollment rates are one way that policy makers assess the performance of
Medicare Advantage (MA) health plans. We use 3 years of data published by the
Centers for Medicare & Medicaid Services (CMS) to examine the
characteristics of MA contracts with high disenrollment rates from 2015 to 2017
and the relationship between disenrollment rates in MA contracts and 6 patient
experiences of care performance measures. We find that MA contracts with high
disenrollment rates were significantly more likely to be for-profit, small, and
enroll a greater proportion of low-income and disabled individuals. After
adjusting for plan characteristics, contracts with the highest levels of
disenrollment were statistically significantly more likely to perform poorly on
all 6 patient experience measures. CMS should consider additional oversight of
MA contracts with high levels of disenrollment and consider publishing
disenrollment rates at the plan level instead of at the contract level.
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Affiliation(s)
- Eva DuGoff
- 1 University of Maryland School of Public Health, College Park, MD, USA.,2 University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sandra Chao
- 1 University of Maryland School of Public Health, College Park, MD, USA.,3 Mathematica Policy Research, Princeton, NJ, USA
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Hohmann N, Hansen R, Garza KB, Harris I, Kiptanui Z, Qian J. Association between Higher Generic Drug Use and Medicare Part D Star Ratings: An Observational Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1186-1191. [PMID: 30314619 DOI: 10.1016/j.jval.2018.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/22/2018] [Accepted: 03/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Increasing generic drug use, due to potential for cost savings and drug access, is a viable consideration for Medicare prescription drug plans to achieve high star ratings and improve quality of plan offerings for Medicare beneficiaries. OBJECTIVE To examine the association between contract-level proportion of generic drugs dispensed (pGDD) and Medicare Part D star ratings. METHODS This was a retrospective study of linked 2011 Medicare Part D star rating data with contract-level pGDD data. A total of 477 individual Medicare prescription contracts were included, representing 75% of total Prescription Drug Plans and more than 65% of total Medicare Advantage Prescription Drug Plans available by the end of 2010. Primary outcomes were Medicare Part D summary and domain star ratings (1-5 indicating lowest to highest performance), incorporating a range of quality measures for access, cost, beneficiary satisfaction, and health services outcomes and processes. Ordinal logistic regression models were used to examine associations between pGDD and Medicare Part D summary and domain star ratings, controlling for contract type and number of beneficiary enrollment. RESULTS Higher pGDD was associated with higher summary star ratings (adjusted odds ratio 1.08 with 95% confidence interval 1.04-1.12) and higher "member experience with drug plan" domain ratings (adjusted odds ratio 1.07 with 95% confidence interval 1.03-1.11). CONCLUSIONS Prescription formulary benefit design targeting increasing generic drug use appears to be associated with improved member experience and higher plan star ratings. Consideration may be given to incorporating pGDD into Medicare Part D star rating measures to improve quality of prescription plans.
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Affiliation(s)
- Natalie Hohmann
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Richard Hansen
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | - Kimberly B Garza
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA
| | | | | | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Auburn University Harrison School of Pharmacy, Auburn, AL, USA.
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4
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Yuan Y, Louis C, Cabral H, Schneider JC, Ryan CM, Kazis LE. Socioeconomic and Geographic Disparities in Accessing Nursing Homes With High Star Ratings. J Am Med Dir Assoc 2018; 19:852-859.e2. [DOI: 10.1016/j.jamda.2018.05.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/26/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
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Almodovar AS, Axon DR, Coleman AM, Warholak T, Nahata MC. The Effect of Plan Type and Comprehensive Medication Reviews on High-Risk Medication Use. J Manag Care Spec Pharm 2018; 24:416-422. [PMID: 29694292 PMCID: PMC10397681 DOI: 10.18553/jmcp.2018.24.5.416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers. OBJECTIVE To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use. METHODS This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years. Performance data were downloaded per Medicare contract from the CMS. We matched Medicare insurance provider performance data with the enrollment data of each contract. Mann Whitney U and Spearman rho tests and a hierarchical linear regression model assessed the relationship between provider characteristics, high-risk medication use, and CMR completion rate outcome measures. RESULTS In 2014, an inverse correlation between CMR completion rate and high-risk medication use was identified among MAPD plan providers. This relationship was further strengthened in 2015. No correlation was detected between the CMR completion rate and high-risk medication use among PDP plan providers in either year. A multivariate regression found an inverse association with high-risk medication use among MAPD plan providers in comparison with PDP plan providers in 2014 (beta = -0.358, P < 0.001) and 2015 (beta = -0.350, P < 0.001), the CMR completion rate in 2015 (beta = -0.221, P < 0.001), and enrollee population size in 2015 (beta = -0.203, P = 0.001). CONCLUSIONS This study found that MAPD plan providers and higher CMR completion rates were associated with lower use of high-risk medications among beneficiaries. DISCLOSURES No outside funding supported this study. Silva Almodovar reports a fellowship funded by SinfoniaRx, Tucson, Arizona, during the time of this study. The other authors have nothing to disclose.
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Min A, Scott LD, Park C, Vincent C, Ryan CJ, Lee T. Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units. Int J Health Plann Manage 2018; 33:733-745. [PMID: 29635856 DOI: 10.1002/hpm.2528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 11/08/2022] Open
Abstract
This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors.
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Affiliation(s)
- Ari Min
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Linda D Scott
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Chang Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Catherine Vincent
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Catherine J Ryan
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Taewha Lee
- College of Nursing, Yonsei University, Seoul, South Korea
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Rosenkrantz AB, Fleming M, Duszak R. Variation in Screening Mammography Rates Among Medicare Advantage Plans. J Am Coll Radiol 2017; 14:1013-1019. [DOI: 10.1016/j.jacr.2017.01.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 01/09/2017] [Accepted: 01/18/2017] [Indexed: 10/19/2022]
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Ta JT, Erickson SC, Qiu WA, Patel BV. Is There a Relationship Between Part D Medication Adherence and Part C Intermediate Outcomes Star Ratings Measures? J Manag Care Spec Pharm 2017; 22:787-95. [PMID: 27348279 PMCID: PMC10397682 DOI: 10.18553/jmcp.2016.22.7.787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improvements in the Centers for Medicare & Medicaid Services (CMS) star ratings Part D medication adherence measures may affect performance in Part C intermediate outcome measures for which the Part D targeted medication classes are prescribed. OBJECTIVE To determine if Part D medication adherence measures are associated with corresponding Part C intermediate outcome measures. METHODS This was a cross-sectional analysis using the CMS 2015 star ratings report (based on 2013 benefit year plan data) for Medicare contracts. The measures of interest included the Part D adherence measures for diabetes medications, antihypertensive agents, and statins and the Part C intermediate outcome measures for controlled blood sugar, blood pressure, and cholesterol. All Medicare Advantage Prescription Drug (MAPD) contracts with complete data for all Part C and D measures of interest were included. Contracts with ≥ 25% of total enrollment with MA-only benefit were excluded. Linear and logistic regression models were used to assess the association between 2015 Part D adherence measures and Part C intermediate outcome measures (n = 366). The regression models were adjusted for low-income subsidy (LIS) beneficiary enrollment and log-transformed (natural logarithm) total contract enrollment. RESULTS Bivariate linear regression models demonstrated moderate positive associations between each of the 2015 Part D adherence scores and related 2015 Part C measures that explained 27%-29% (R(2)) of variance. Including LIS and total contract enrollment in the regression models increased the R2 to 30%-36%. The multivariate logistic regression models showed that each percentage point of improvement in the 2015 Part D adherence measures was associated with a 4.13 to 4.69 greater odds of performing in the top quartile in corresponding 2015 Part C measures. CONCLUSIONS Moderate positive associations were observed between the Part D and Part C scores in the same benefit year. MAPD plans may observe improved Part C intermediate outcome measures with strategies that improve Part D medication adherence measures. DISCLOSURES This study was conducted by MedImpact Healthcare Systems, San Diego, California, without external funding. All authors are employees of MedImpact Healthcare Systems. Erickson reports advisory board fees from Sanofi and AstraZeneca. Ta, Erickson, and Patel were responsible for study concept and design and data interpretation, with assistance from Qiu. Qiu and Ta took the lead in data collection, assisted by Erickson. Ta wrote the manuscript, which was revised by Erickson and Patel.
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Affiliation(s)
- Jamie T Ta
- 1 University of California, San Diego, Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, California, and Specialty Pharmacy Research Assistant, MedImpact Healthcare Systems, San Diego, California
| | | | | | - Bimal V Patel
- 2 MedImpact Healthcare Systems, San Diego, California
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Natafgi N, Nattinger M, Ugwi P, Ullrich F, Wolinsky FD. The impact of the affordable care Act (ACA) on favorable risk selection and Beneficiaries' health status in Medicare advantage: a preliminary assessment. BMC Health Serv Res 2016; 16:404. [PMID: 27539191 PMCID: PMC4990876 DOI: 10.1186/s12913-016-1663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In response to increasing fiscal pressures, the Affordable Care Act (ACA) sought to reduce Medicare Advantage plan expenses by restructuring the bidding and payment processes. The purpose of this study is to assess the effects of the ACA's payment freeze and restructuring of the bidding and payment processes on favorable risk selection in Medicare Advantage plan enrollment (objective 1) and changes in the health status of beneficiaries enrolled in Medicare Advantage plans over time (objective 2). METHODS We used the Medicare Health Outcome Survey baseline data (2007→2013) for analyses of the first objective (7 cohorts, 1.7 million beneficiaries) and the linked baseline and follow-up data (2007-2009→2011-2013) for analyses of the second objective (5 cohorts, 0.5 million beneficiaries). To examine favorable risk selection we used the following outcomes: self-rated health, falls, balance problems, falls management, frailty, and morbidity. To examine changes in beneficiary health status over time, we examined changes (over time) in these same outcomes. The focal independent variable is the policy implementation measure, which is time dependent and measures the accumulation of changes to Medicare Advantage payment policies resulting from the ACA. Multiple regression models were developed to examine the relationship between ACA implementation and outcomes of interest. RESULTS In terms of favorable selection, individuals enrolled in Medicare Advantage plans post-ACA have, on average, better self-rated health (b = 0.003, p < 0.01), lower odds of falls (AOR = 0.981, p < 0.001), higher odds of falls management (AOR = 1.040, p < 0.001), lower frailty risks (IRR = 0.983, p < 0.001), and lower risks of comorbidities (IRR = 0.989, p < 0.001). In terms of health status changes over time, the results indicate that in the post-ACA period, beneficiaries reported better self-rated health (b = 0.028, p < 0.001), lower odds of falls (AOR = 0.965, p < 0.001), lower odds of balance problems (AOR = 0.958, p < 0.001), lower odds of falls management (AOR = 0.981, p < 0.05), lower frailty risks (IRR = 0.944, p < 0.001), and lower risks of comorbidity (IRR = 0.986, p < 0.001) at follow up compared to the same risks at baseline. CONCLUSIONS These findings suggest that as the Medicare Advantage payment policies in the ACA were being implemented, plans may have engaged in favorable selection activities, yet beneficiaries exhibited more favorable health outcomes.
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Affiliation(s)
- Nabil Natafgi
- Department of Health Management and Policy, College of Public Health University of Iowa, 145 River Side Drive, Iowa City, IA 52241 USA
| | - Matthew Nattinger
- Department of Health Management and Policy, College of Public Health University of Iowa, 145 River Side Drive, Iowa City, IA 52241 USA
| | - Patience Ugwi
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 USA
| | - Fred Ullrich
- Department of Health Management and Policy, College of Public Health University of Iowa, 145 River Side Drive, Iowa City, IA 52241 USA
| | - Fredric D. Wolinsky
- Department of Health Management and Policy, College of Public Health University of Iowa, 145 River Side Drive, Iowa City, IA 52241 USA
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10
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Li P, Doshi JA. Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment before and after Implementation of Quality-Related Bonus Payments in 2012. PLoS One 2016; 11:e0154357. [PMID: 27149092 PMCID: PMC4858248 DOI: 10.1371/journal.pone.0154357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/12/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Since 2007, the Centers for Medicare and Medicaid Services have published 5-star quality rating measures to aid consumers in choosing Medicare Advantage Prescription Drug Plans (MAPDs). We examined the impact of these star ratings on Medicare Advantage Prescription Drug (MAPD) enrollment before and after 2012, when star ratings became tied to bonus payments for MAPDs that could be used to improve plan benefits and/or reduce premiums in the subsequent year. METHODS A longitudinal design and multivariable hybrid models were used to assess whether star ratings had a direct impact on concurrent year MAPD contract enrollment (by influencing beneficiary choice) and/or an indirect impact on subsequent year MAPD contract enrollment (because ratings were linked to bonus payments). The main analysis was based on contract-year level data from 2009-2015. We compared effects of star ratings in the pre-bonus payment period (2009-2011) and post-bonus payment period (2012-2015). Extensive sensitivity analyses varied the analytic techniques, unit of analysis, and sample inclusion criteria. Similar analyses were conducted separately using stand-alone PDP contract-year data; since PDPs were not eligible for bonus payments, they served as an external comparison group. RESULT The main analysis included 3,866 MAPD contract-years. A change of star rating had no statistically significant effect on concurrent year enrollment in any of the pre-, post-, or pre-post combined periods. On the other hand, star rating increase was associated with a statistically significant increase in the subsequent year enrollment (a 1-star increase associated with +11,337 enrollees, p<0.001) in the post-bonus payment period but had a very small and statistically non-significant effect on subsequent year enrollment in the pre-bonus payment period. Further, the difference in effects on subsequent year enrollment was statistically significant between the pre- and post-periods (p = 0.011). Sensitivity analyses indicated that the findings were robust. No statistically significant effect of star ratings was found on concurrent or subsequent year enrollment in the pre- or post-period in the external comparison group of stand-alone PDP contracts. CONCLUSION Star ratings had no direct impact on concurrent year MAPD enrollment before or after the introduction of bonus payments tied to star ratings. However, after the introduction of these bonus payments, MAPD star ratings had a significant indirect impact of increasing subsequent year enrollment, likely via the reinvestment of bonuses to provide lower premiums and/or additional member benefits in the following year.
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Affiliation(s)
- Pengxiang Li
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail:
| | - Jalpa A. Doshi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
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Reid RO, Deb P, Howell BL, Conway PH, Shrank WH. The Roles of Cost and Quality Information in Medicare Advantage Plan Enrollment Decisions: an Observational Study. J Gen Intern Med 2016; 31:234-241. [PMID: 26282952 PMCID: PMC4720649 DOI: 10.1007/s11606-015-3467-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/10/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND To facilitate informed decision-making in the Medicare Advantage marketplace, the Centers for Medicare & Medicaid Services publishes plan information on the Medicare Plan Finder website, including costs, benefits, and star ratings reflecting quality. Little is known about how beneficiaries weigh costs versus quality in enrollment decisions. OBJECTIVE We aimed to assess associations between publicly reported Medicare Advantage plan attributes (i.e., costs, quality, and benefits) and brand market share and beneficiaries' enrollment decisions. DESIGN, SETTING, PARTICIPANTS We performed a nationwide, beneficiary-level cross-sectional analysis of 847,069 beneficiaries enrolling in Medicare Advantage for the first time in 2011. MAIN MEASURES Matching beneficiaries with their plan choice sets, we used conditional logistic regression to estimate associations between plan attributes and enrollment to assess the proportion of enrollment variation explained by plan attributes and willingness to pay for quality. KEY RESULTS Relative to the total variation explained by the model, the variation in plan choice explained by premiums (25.7 %) and out-of-pocket costs (11.6 %) together explained nearly three times as much as quality ratings (13.6 %), but brand market share explained the most variation (35.3 %). Further, while beneficiaries were willing to pay more in total annual combined premiums and out-of-pocket costs for higher-rated plans (from $4,154.93 for 2.5-star plans to $5,698.66 for 5-star plans), increases in willingness to pay diminished at higher ratings, from $549.27 (95 %CI: $541.10, $557.44) for a rating increase from 2.5 to 3 stars to $68.22 (95 %CI: $61.44, $75.01) for an increase from 4.5 to 5 stars. Willingness to pay varied among subgroups: beneficiaries aged 64-65 years were more willing to pay for higher-rated plans, while black and rural beneficiaries were less willing to pay for higher-rated plans. CONCLUSIONS While beneficiaries prefer higher-quality and lower-cost Medicare Advantage plans, marginal utility for quality diminishes at higher star ratings, and their decisions are strongly associated with plans' brand market share.
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Affiliation(s)
- Rachel O Reid
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
| | - Partha Deb
- Centers for Medicare & Medicaid Services, Center for Medicare & Medicaid Innovation, Baltimore, MD, USA
- Department of Economics, Hunter College, New York, NY, USA
| | - Benjamin L Howell
- Centers for Medicare & Medicaid Services, Center for Medicare & Medicaid Innovation, Baltimore, MD, USA
| | - Patrick H Conway
- Centers for Medicare & Medicaid Services, Center for Medicare & Medicaid Innovation, Baltimore, MD, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William H Shrank
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Centers for Medicare & Medicaid Services, Center for Medicare & Medicaid Innovation, Baltimore, MD, USA
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12
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The Role of Geography in the Assessment of Quality: Evidence from the Medicare Advantage Program. PLoS One 2016; 11:e0145656. [PMID: 26727371 PMCID: PMC4703195 DOI: 10.1371/journal.pone.0145656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/07/2015] [Indexed: 11/19/2022] Open
Abstract
The Affordable Care Act set in motion a renewed emphasis on quality of care evaluation. However, the evaluation strategies of quality by the Centers for Medicare and Medicaid Services do not consider geography when comparisons are made among plans. Using an overall measure of a plan's quality in the public sector--the Medicare Advantage (MA) star ratings--we explored the impact of geography in these ratings. We identified 2,872 U.S counties in 2010. The geographic factor predicted a larger fraction of the MA ratings' compared to socio-demographic factors which explained less. Also, after the risk adjustments, almost half of the U.S. states changed their ranked position in the star ratings. Further, lower MA star ratings were identified in the Southeastern region. These findings suggest that the geographic component effect on the ratings is not trivial and should be considered in future adjustments of the metric, which may enhance the transparency, accountability, and importantly level the playing field more effectively when comparing quality across health plans.
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