AHIP Published In Health Affairs on Medicare Advantage Star System

WASHINGTON, Sept. 23 -- America's Health Insurance Plans issued the following news release:

To prevent disruption and ensure high-quality care for low-income beneficiaries, policymakers should consider adjustments to the Medicare Advantage Star Ratings System so it accurately reflects the challenges of serving vulnerable populations. Improving the Star System would enable health plans to better address the complex health needs of low-income beneficiaries, two AHIP experts on public health care programs write in a new article posted on Health Affairs.

The report outlines an analysis by AHIP's Howard Weiss and Sara Pescatello examining 2011-2014 Star Ratings. They found the government's five-star quality rating system for Medicare Advantage threatens the long-term viability of health plans focusing on low-income vulnerable populations, who are more likely to have multiple chronic diseases, cognitive impairments, or need help with daily living activities.

Medicare Advantage plans serving low-income populations are systematically disadvantaged by the Star Ratings System when looking at performance on overall star ratings, individual measures, and by measure type. As Weiss and Pescatello highlight, prior research has shown factors outside of health plans' control, including education, socioeconomic status, and health status, largely contribute to increased barriers to achieving high performance, and medication adherence is an example where plans experience difficulty overcoming these challenges.

The Medicare Advantage Star Ratings System does not adequately take into account differences in the socioeconomic characteristics of enrollee populations when determining scores, which affects payment incentives for high performance put in place by health care reform.

The performance gap between Medicare Advantage plans focused on low-income populations and other plans is growing due to the unique challenges of serving vulnerable enrollee populations, according to the analysis. Without addressing those challenges, the Star System, which aims to reward quality, may actually negatively affect our most vulnerable populations.

"Changes are necessary to avoid disruption for the very beneficiaries who stand to benefit most from the prevention and disease management offered by MA plans," write Weiss and Pescatello in Health Affairs.

To view the full post click here (http://healthaffairs.org/blog/2014/09/22/medicare-advantage-stars-systems-disproportionate-impact-on-ma-plans-focusing-on-low-income-populations/).

[Category: Insurance]

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