Report: Many Medicare Advantage Beneficiaries in Lower-Rated Plans
Nearly half of Medicare Advantage beneficiaries are enrolled in plans that received medium-to-fair quality ratings, while just 23% have plans of very good to excellent quality, according to a report released Thursday by Avalere Health, the AP/San Francisco Chronicle reports (Alonso-Zaldivar, AP/San Francisco Chronicle, 4/29).
For the analysis, Avalere compared MA enrollment data with CMS' 2010 Part C Report Card, which assigns "star" ratings for quality (CQ HealthBeat, 4/29). The rating system is based on several factors, including customer service, prevention and care for chronic conditions (AP/San Francisco Chronicle, 4/29). Five stars is the highest rating.
The report found that about 47% of MA beneficiaries are enrolled in plans with ratings of three stars or below, while 38% are enrolled in plans with ratings of 3.5 stars or above (CQ HealthBeat, 4/29). Specifically, only 23% chose plans receiving the highest ratings of four or five stars. About one in four Medicare beneficiaries, or about 11 million U.S. residents, are enrolled in MA plans.
Change Under Overhaul Will Link Payments to Quality
Regardless of quality rating, MA plans receive payments that are on average 9% higher than traditional Medicare, the AP/Chronicle reports. The new health reform law cuts funding to MA plans beginning in 2011. Also, under the overhaul, MA plans that receive quality ratings of four stars or better will qualify for payment bonuses beginning in 2012.
Dan Mendelson, president of Avalere, said, "These ratings are about to become much more important." He added, "When you start linking quality to payment, you can bet the plans are going to be very motivated to bring the scores up" (AP/San Francisco Chronicle, 4/29).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.