The Centers for Medicare & Medicaid Services has a lot of data on Medicare Advantage plans that it should be using to inform policy and make available to the public, according to a new Inspector General report.
Since 2009, CMS has collected data from Medicare Advantage organizations, via a contract with the company Acumen, on 13 measurements, including benefit utilization, network adequacy, adverse events, grievances and special needs plans care management. [The agency later ended reporting requirements for benefit utilization, provider networks and four other measurements, but said it's still gets the data from sources other than the plans.]
With all of that data regularly collected and analyzed by Acumen, the HHS Inspector General argues that CMS could be using it to guide policy decisions and inform seniors -- as the agency had in mind when it started the program.
"Despite its investments in contractor reviews of the data, CMS has made limited use of the Part C Reporting Requirements data," OIG staff wrote in a recent report scrutinizing the MA reporting program during 2010 and 2011.
In those two years, 638 Medicare Advantage organizations submitted data to CMS, and Acumen found more than 2,000 data issues from more than 500 organizations, including 1,904 outlier incidents and 50 incidents of inconsistent data.
"CMS did not contact any MA organizations to determine the cause of the outlier data values identified by Acumen or to ensure that inconsistent data were corrected," the OIG found. "CMS also did not follow up with MA organizations to address data submitted with placeholder values." The agency followed up with MA organizations only for overdue data, issuing noncompliance notices to MA organizations, the HHS watchdog found.
For the roughly 1,900 incidents of outlier data, CMS could have followed up to determine whether it reflected "inaccurate reporting or atypical performance," the OIG wrote.
Most of MA organizations have scored well on the independent annual audits of Part C reporting that CMS started requiring in 2010, but the agency should make that data publicly available, the OIG argued, since that was listed as a goal in the original contract with Acumen.
CMS could also be using Acumen's MA analysis reports and performance scores in its contract decisions, OIG staff argued in the report.
However, CMS staff told the OIG that that data is too limited to "establish benchmarks for 'good' or 'poor' performance" and that there are "factors much larger than just Part C Reporting Requirements data."
In any case, CMS might start using some of the Part C reporting data in its Medicare Advantage star ratings in 2015, specifically the special needs plans care management measures. The agency also recently started posting data on grievances and special needs plans care management on CMS.gov's performance data page.