Reports Summarize Insurance Study Results from RAND Corporation (Understanding the Social Risk Factor Adjustment’s Effect On Star Ratings): Insurance

2024 MAR 28 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Fresh data on Insurance are presented in a new report. According to news reporting originating from Santa Monica, California, by NewsRx correspondents, research stated, “CMS implemented the Categorical Adjustment Index (CAI) to address measurement bias in the Medicare Advantage (MA) Star Ratings, as unadjusted scores may disadvantage MA contracts serving more enrollees at greater social risk. CAI values are added to a contract’s Star Ratings to adjust for the mean within -contract performance disparity associated with its percentage of enrollees with low socioeconomic status (ie, receipt of a Part D low-income subsidy or dual eligibility for Medicare and Medicaid [LIS/ DE]) and who are disabled.”

Our news editors obtained a quote from the research from RAND Corporation, “We examined the CAI’s effect on Star Ratings and the type of contracts affected. Observational study of MA contracts with health and prescription drug coverage. We compared adjusted and unadjusted 2017-2020 Star Ratings overall and by contracts’ proportion of LIS/DE and disabled enrollees. We assessed the CAI’s effect on qualifying for quality bonus payments (QBPs), eligibility for rebate payments, and high -performing and low -performing designations. The CAI’s impact was modest overall (3.2%-14.9% of contracts experienced one-half Star Rating changes). Upward changes were concentrated among contracts with high percentages of LIS/DE or disabled enrollees (7.7%-32.3% of these contracts saw increased Star Ratings). In 2020, 26.0% of contracts with a high proportion of LIS/DE or disabled enrollees that qualified for a QBP did so because of the CAI. The CAI primarily affected contracts with high LIS/DE or disabled enrollment, which received higher Star Ratings because of the CAI.”

According to the news editors, the research concluded: “The adjustment helps ensure that such contracts’ performance is not understated and reduces incentives for MA contracts to avoid patients at greater social risk.”

This research has been peer-reviewed.

For more information on this research see: Understanding the Social Risk Factor Adjustment’s Effect On Star Ratings. The American Journal of Managed Care, 2023;29(12). The American Journal of Managed Care can be contacted at: Managed Care & Healthcare Communications Llc, 666 Plainsboro Rd, Ste 300, Plainsboro, NJ 08536, USA.

The news editors report that additional information may be obtained by contacting Anagha Tolpadi, RAND Corporation, 1776 Main St, Santa Monica, CA 90401, United States. Additional authors for this research include Maria DeYoreo, Marc N. Elliott, Cheryl L. Damberg and Melony E. Sorbero.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.37765/ajmc.2023.89471. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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