Medicare Advantage Star Ratings

David Meyers and colleagues (Feb 2021) examine the effects of Medicare Advantage (MA) star ratings on patient outcomes by studying what happens when enrollees are shifted to higher-rated plans via contract consolidation. Several issues raise questions about their findings.

The authors contend that enrollees who are shifted into consolidated contracts experience a change in benefits, provider networks, or care delivery. But contract consolidation does not necessarily mean that enrollees change MA plans or experience any changes; rather, it means that the plan in which they are enrolled falls under a different contract number held by the same company. As a consequence, changes in quality outcomes at the contract level in the subsequent year might not apply to enrollees from the “consumed” contract. The authors also speculate that reduced likelihood of voluntary disenrollment is due to greater enrollee satisfaction with the quality provided by their “new” plan, which is hard to substantiate without plan-level detail. Because MA sponsors of consolidated contracts must use their bonuses to provide more generous supplemental benefits, enrollees may stay to receive such benefits, as we found in a recent study.¹ Also, one year is too short to capture real changes in contract-level quality ratings after consolidation. The real test is whether the MA sponsor can sustain higher ratings in the surviving contract after that.

Because MA star ratings are reported at the contract level, they mask differences among individual plans within each contract—a problem that is exacerbated when MA sponsors use contract consolidation to boost star ratings and secure unwarranted bonus payments.² That is why we and others recommend that the Centers for Medicare and Medicaid Services (CMS) report MA star ratings at the plan level. The sooner CMS does so, the better it will be for enrollees who use the ratings to choose MA plans and for researchers to understand what really drives improved outcomes.

NOTES

1 Lipson DJ, Kimmey L, Chelminsky D, Margiotta C, Tourtellotte A, Weir Lakhmani E. Why dually eligible beneficiaries stay or leave integrated care plans [Internet]. Washington (DC): Mathematica; 2021 Jan 15 [cited 2021 Apr 21]. Available from: https://www.mathematica.org/our-publications-and-findings/publications/why-dually-eligible-beneficiaries-stay-or-leave-integrated-care-plans Google Scholar

2 Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy [Internet]. Washington (DC): MedPAC; 2019 Mar. Chapter 13, The Medicare Advantage program: status report; [cited 2021 Apr 30]. Available from: http://medpac.gov/docs/default-source/reports/mar19_medpac_ch13_sec.pdf Google Scholar