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

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.