Dive Brief:
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Medicare Advantage (MA) plans with a larger percentage of disadvantaged populations would have better relative rankings for three important outcome measures if CMS included socioeconomic factors in risk-adjustment models, according to a new Health Affairs study.
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Plans in the study improved by one or more quintiles in ranking for diabetes, cholesterol and blood pressure measures once researchers considered socioeconomic and demographic factors. Researchers evaluated Medicare Healthcare Effectiveness Data and Information Set data for 2012 and 2013 and used enrollee ZIP codes to measure neighborhood disadvantage and how rural the area is.
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MA beneficiaries use these star ratings to help them choose plans, and lower ratings can mean smaller bonuses for payers.
Dive Insight:
More MA participants are getting into plans with four or more stars, including 73% of enrollees last year, according to CMS. However, the percentage of plans that received a 5% quality bonus for reaching four or five stars dropped from 49% to 44% this year.
About one-third of Medicare beneficiaries are currently in MA plans, and that percentage is expected to continue to rise. The MA market is a stable and attractive one for payers, who are increasing their offerings in the area. As more people used to having employer-sponsored plans age into Medicare, popularity of MA plans shows no signs of slowing.
The study's authors noted that adjusting clinical performance measures for socioeconomic factors is controversial, but doing so "could produce fairer comparisons of Medicare Advantage plans' performance and reduce incentive to avoid caring for disadvantaged populations."
Taking sociodemographics into account is becoming more common for payers and providers. Social determinants of health are important factors for overall health outcomes. Neighborhood, employment, access to healthcare, homelessness, lacking transportation and other factors affect a person’s health.
In response, the healthcare industry has increasingly looked to adjust clinical performance measures for socioeconomic factors. Supporters of making the change for MA plans say it creates more complete plan comparisons. However, critics charge that risk adjustments would lower the bar for plans serving disadvantaged populations.