The complexities of managing dual eligibles may cause difficulties for health plans and providers trying to achieve improved quality outcomes.
A recent study from healthcare solutions provider Inovalon used its medical outcomes registry to examine data for nearly 3 million members in 80 Centers for Medicare & Medicaid Services Medicare Advantage contracts from 2011 and 2012. The results showed that dual-eligible members performed worse on nine of the 10 Medicare Advantage Star ratings measures that were studied than did non-dual-eligible members. Furthermore, while controlling for demographics, socioeconomic characteristics and severity of illness, the study found that dual-eligible members consistently underperform in eight of the 10 measures investigated.
"These findings suggest that the Five-Star ratings system, in its current state may penalize MA plans serving a high proportion of dual eligible beneficiaries," Inovalon said in a press release announcing the study's results. "Lower Star ratings result in lower incentive payments and may lead to reduced services to dual eligibles … ."
Plans serving predominantly dual-eligible and special needs populations are rated on the same scale as other Medicare Advantage plans for quality reporting and incentive payments.
More research into benchmarking and refinement of Star quality measures may be needed to assure fair comparisons of performance across Medicare Advantage plans serving different populations, Inovalon noted in its press release.
Paige Kilian, MD, vice president of clinical analytics at Inovalon said in the news release that she hopes the study will shed light "on the obstacles that health plans may face and that it helps to inform future discussions that will improve quality outcomes and care."