Is Medi­care’s star rat­ing fair to plans serv­ing dual-el­i­gi­bles?

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dick­son

Health plan lead­ers and pol­icy ex­perts this week will ex­am­ine whether the CMS’ star-rat­ing sys­tem is a fair way of eval­u­at­ing the per­for­mance of Medi­care Ad­van­tage plans that serve a large share of peo­ple who are du­ally el­i­gi­bly for Med­i­caid and Medi­care.

The 5th An­nual Gov­ern­ment Health Care Congress Med­i­caid Sum­mit in Ar­ling­ton, Va., runs July 14-16. At the con­fer­ence, ex­perts will dis­cuss the per­for­mance rat­ing chal­lenge for plans serv­ing dual-el­i­gi­bles, who are low­in­come se­niors or peo­ple with phys­i­cal and/or cog­ni­tive dis­abil­i­ties. They are among the high­est-cost ben­e­fi­cia­ries in the two public pro­grams.

Plans that have the most ex­pe­ri­ence in serv­ing du­als tend to have the low­est star rat­ings be­cause du­als may not have the phys­i­cal or men­tal ca­pa­bil­i­ties to par­tic­i­pate fully in man­ag­ing their own health or to com­plete mem­ber sat­is­fac­tion sur­veys. Both those fac­tors con­trib­ute to a plan’s star rat­ing. “The literature has been clear for years that cer­tain so­cio-eco­nomic fac­tors have an ef­fect on health and health out­comes,” said Richard Bringe­watt, co-founder and chair­man of the SNP Al­liance, which rep­re­sents spe­cial­needs health plans.

Medi­care Ad­van­tage plans can be kicked out of the pro­gram if they get two or less stars for three years in a row.

At­ten­dees at the con­fer­ence will dis­cuss pro­pos­als for a re­vamped star sys­tem, or a sep­a­rate star sys­tem for spe­cial-needs plans.

A re­cent study by Ino­valon found that ben­e­fi­cia­ries with so­cio-eco­nomic dis­ad­van­tages or se­vere chronic health prob­lems have worse health out­comes that can’t be at­trib­uted to the qual­ity of a health plan.

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