Posted on May 6, 2010 12:11
Categories: Medicare | Special Populations
Topics: Access/Barriers | Medicare | Rates/Reimbursement | Seniors
On April 29, Avalere Health released a study that found that only 23 percent of seniors in Medicare Advantage plans are enrolled in plans which received four or five out of five stars under the government’s rating system for Medicare Advantage plans. The study found that 47 percent of enrollees are covered under plans that received two or three stars. The ratings of the plans are significant because under the national health care reform law, starting in 2012, plans with four or more stars will be eligible for bonuses of up to five percent of local fee-for-service costs. These plans will also be allowed to keep a larger percentage of the rebate money used to enhance benefits and reduce beneficiary cost sharing.
From the press release:
The star rating system is run by the Centers for Medicare and Medicaid Services (CMS), and was put in place as part of an effort to help educate consumers on quality and make quality data more transparent. Its summary ratings are based on five major domains: staying healthy via preventive services such as screenings and vaccines; managing chronic conditions; ratings of plan responsiveness and care; complaints, appeals, and voluntary disenrollment; and telephone customer service.
Avalere analyzed the CMS 2010 Part C Report Card, released in November 2009, and enrollment data released in April 2010 to see whether beneficiaries’ plan selections correspond with 5-star quality ratings assigned by the government. According to Avalere’s analysis, 47.2% of MA enrollees are in plans with a ‘3’ or below rating, while 38.7% are in plans rated ‘3.5’ and up. Only 0.3% of MA enrollees are in a ‘5’ star, or top-rated, plan. Another 14.1% are unaccounted for, due to a plan being too new to measure or having insufficient data to calculate the contract score.
For the press release and to request a copy: http://www.avalerehealth.net/wm/show.php?c=1&id=854
Avalere Health. (2010). A majority of Medicare Advantage beneficiaries are enrolled in plans with medium to low quality as ranked by the government.
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