How well does the Medicare Advantage 5-star ratings system capture enrollee outcomes and experience?

Medicare Advantage 5 星级评级系统在多大程度上体现了参保者的成果和体验？

• 批准号: 9815495
• 负责人: David Joseph Meyers
• 金额: $ 4.31万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9815495
• 关键词: How; well; does; Medicare; Advantage

PROJECT SUMMARY The federal Medicare program has invested substantial resources into publically reporting and providing financial incentives for the quality of care in Medicare Advantage (MA) plans using a 5-star rating system, but the validity of these quality ratings remain unknown. Enrollees with worse health status and more complex care needs disproportionately disenroll from MA into Traditional Medicare (TM) and higher rated plans tend to enroll healthier, less socio-demographically disadvantaged beneficiaries. It is unknown whether plan performance ratings reflect the actual provision of better quality of care, or if they are driven by favorable selection. Without a better understanding of the performance of the 5-star rating system, CMS’s current efforts to measure and report plan quality may provide further incentives to avoid high-need beneficiaries, and not reflect the quality of care for these individuals. This study’s long term goal is to identify policy strategies to improve the performance of MA in addressing enrollee needs. Its immediate objective is to identify the relationship between the MA 5- star rating system and the outcomes beneficiaries experience. The central hypothesis is that while there may be improvements in network quality among higher rated contracts, the current incentives and methodologies behind the rating system may not optimize patient outcomes. The study proposes two specific aims: 1) To estimate the impact of improved star ratings on enrollee network quality and enrollee health outcomes, and 2) To evaluate the role of biased disenrollment on subsequent star ratings. To answer both aims this study will use data from the Master Beneficiary Summary file, the Healthcare Effectiveness Data and Information Set (HEDIS), the Health Outcomes Survey (HOS), and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) for all Medicare Advantage enrollees in 2015 and 2016. MA companies often consolidate low rated contracts into higher rated contracts, moving all enrollees from one contract often into a higher rated one without enrollee selection. In aim one, this study will use this contract consolidation as an exogenous instrument to measure the impact of an improved star rating on an enrollee’s observable and self- reported outcomes. In aim two, this study will use available beneficiary level data to see how different enrollees contribute to a contract’s overall rating, and evaluate the impact of disenrollment among chronically ill enrollees on future year ratings. The proposed work is innovative because it combines a unique set of data that has not been previously linked at this scale and it employs a novel quasi-experimental design to study the effect of star ratings on enrollee outcomes. The proposed work is significant because over 18 million Medicare beneficiaries rely on these star ratings to ensure their plans are providing them with an adequate quality of care. Insights gained from this work will help CMS to improve on the star rating program and the design of incentives in the MA program, to maximize the experience of all patients.

项目摘要 联邦医疗保险计划已投入大量资源， 使用5-星星评级系统的Medicare Advantage（MA）计划中的医疗质量的财务激励，但是 这些质量评级的有效性仍然未知。健康状况更差和护理更复杂的入组者 需要不成比例地从MA退出传统医疗保险（TM），并且更高评级的计划倾向于注册 更健康、社会人口弱势程度更低的受益人。目前尚不清楚计划执行情况 评级反映了更好的护理质量的实际提供，或者如果他们是由有利的选择驱动。没有 更好地了解5-星星评级系统的性能，CMS目前的努力，以衡量和 报告计划的质量可能会进一步鼓励避免高需求的受益人，而不是反映 照顾这些人。本研究的长期目标是确定改善绩效的政策策略 在满足学员需求方面。其直接目标是确定MA5- 星星评级系统和受益人体验的成果。核心假设是，虽然可能有 在较高评级的合同、现行激励措施和方法中， 评级系统背后的可能不会优化患者的结果。这项研究提出两个具体目标：1） 估计改进的星星评级对登记者网络质量和登记者健康结果的影响，以及2） 评估有偏见的除名对随后的星星评级的作用。为了实现这两个目标，本研究将 使用来自主受益人摘要文件、医疗保健有效性数据和信息集的数据 （HEDIS），健康结果调查（HOS）和医疗保险消费者医疗保健评估 提供者和系统（CAHPS）在2015年和2016年为所有Medicare Advantage登记者提供服务。公司经常 将低评级合同合并为高评级合同，将所有参与者从一份合同转移到一份合同， 一个更高的评级，没有登记者的选择。在目的一，本研究将使用这种合同合并作为一个 外部工具来测量改进的星星评级对登记者的可观察和自我评价的影响。 报告的结果。在目标二，这项研究将使用现有的受益人水平的数据，看看如何不同的登记 有助于合同的整体评级，并评估慢性病患者的退出的影响 未来一年的评级。拟议的工作是创新的，因为它结合了一组独特的数据， 它采用了一种新颖的准实验设计来研究星星的影响， 对参与者结果的评级。这项拟议的工作意义重大，因为超过1800万医疗保险受益人 依靠这些星星评级来确保他们的计划为他们提供足够质量的护理。见解 从这项工作中获得的将有助于CMS改善星星评级计划和激励措施的设计， MA计划，以最大限度地提高所有患者的经验。