MedPAC finds uneven quality in newer Medicare Advantage plans

Medicare Payment Advisory Commission officials at a meeting on Friday expressed concern over data showing differences in quality among newer Medicare Advantage plans and increasing enrollment in private fee-for-service MA plans, CQ HealthBeat reports.

A Medicare survey designed to assess changes in physical and mental "health outcomes" for people enrolled in MA plans found that over the period 2004 to 2006, beneficiaries in five of the 151 plans rated their mental health as better than expected, compared with beneficiaries in 18 plans during 2003 to 2005 and in 27 plans over 2002 to 2004. In addition, beneficiaries in 13 plans reported that their physical health was worse than expected from the 2004-2006 period, compared with zero plans in the 2003-2005 and 2002-2004 periods.

Separately, National Committee on Quality Assurance data released last month found that commercial and Medicaid managed care plans showed greater improvement on a larger number of quality performance measures compared with MA plans, MedPAC staffer Carlos Zarabozo said. According to Zarabozo, MA plans improved on seven of 38 measures from 2005 to 2006, while commercial plans improved on 30 out of 44 measures and Medicaid plans on 34 out of 43 measures.

In addition, Zarabozo cited data that found 24% of MA plans provided routine eye exams for fewer than 50% of diabetic beneficiaries to assess whether their vision was declining, and about half of the plans provided routine eye exams for fewer than 60% of diabetic beneficiaries. Older MA plans were more likely to provide the exams than plans that signed contracts on or after June 1, 2004. The surveys included data on HMOs and PPOs but not the private fee-for-service plans, which are not required to provide quality data.

Special Needs Plans
The meeting also addressed special needs plans, which are experiencing a surge in enrollment and receive higher reimbursement than other MA plans. SNPs are intended to improve quality and lower costs by more carefully managing care for chronically ill Medicare beneficiaries. However, SNPs are not subject to requirements to ensure that they offer that type of specialized care, according to MedPAC staffer Jennifer Podulka.

Podulka issued a set of eight draft recommendations to establish performance measures for SNPs and to evaluate their performance within the next three years. MedPAC in December will vote on the recommendations, "in a bid to influence Medicare legislation pending in Congress," according to CQ HealthBeat.

Comments
Zarabozo at the meeting said, "Evaluating various data sources, what we have found is the most recent data on quality in MA plans show a need for improvement," adding, "They also show that there is a substantial variability across plans in their performance, and performance in newer plans is generally poorer" than performance in the older plans.

MedPAC Chair Glenn Hackbarth said, "A number of things are depressing about these results," adding, "I think that one of them is that I fear that we are going backwards, that the policy changes that we made in this program are converting Medicare Advantage from a program that's leading edge where we reward organized systems that reduce costs and improve quality ... that we're going to private fee for service, that has little potential to do either. These results are just a reflection that we're not evolving, we're devolving."

MedPAC commissioners said that the commission should more forcefully state its position on MA plans: The plans should be accountable for the care they provide and should be paid based on the quality of their performance. Commissioner Nicholas Wolter said, "We want not only reporting, but also performance," adding, "I think we should be very strong on this" when making recommendations to Congress.

Industry Response
Mohit Ghose, spokesperson for America's Health Insurance Plans, said that MedPAC staff should not draw the wrong conclusions from the data, CQ HealthBeat reports. He noted that traditional Medicare does not manage care or evaluate quality of care, meaning that quality of care for that system is largely unknown. Even MA plans with poorer performance have benchmarks against which improvements can be made, Ghose said. Ghose also said that the higher performance of older plans versus new plans should not be surprising because it takes time to enroll beneficiaries in the plan and successfully improve the quality of their care (Reichard, CQ HealthBeat, 11/9).