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

项目总结 联邦医疗保险计划已经投入了大量资源来公开报告和提供 使用五星级评级系统的联邦医疗保险优势(MA)计划中针对护理质量的财务激励，但 这些质量评级的有效性仍不得而知。健康状况较差和护理更复杂的参保者 需求不成比例地从MA退出到传统Medicare(TM)，评级更高的计划往往会加入 更健康、社会人口状况不那么不利的受益者。目前尚不清楚是否计划执行 评级反映了更好的护理质量的实际提供情况，或者是否受到有利选择的推动。如果没有 更好地了解五星级评级系统的表现，CMS目前在衡量和 报告计划的质量可能会提供进一步的激励，以避免高需求的受益人，而不是反映 关爱这些人。这项研究的长期目标是确定政策战略，以提高绩效 MA在满足参与者需求方面的作用。它的直接目标是确定MA 5- 星级评级系统和受益者体验的结果。中心假设是，虽然可能存在 在评级较高的合同中改善网络质量，当前的激励措施和方法 评级系统的背后可能不会优化患者的结果。该研究提出了两个具体目标：1) 评估改进的星级评级对参与者网络质量和参与者健康结果的影响，以及2) 评估有偏见的退学对后续星级评级的作用。为了回答这两个目标，这项研究将 使用主要受益人汇总文件、医疗效果数据和信息集中的数据 (HEDIS)、健康结果调查(HOS)和医疗保健消费者评估 2015年和2016年为所有Medicare Advantage参与者提供的提供商和系统(CAHPS)。马云公司经常 将评级较低的合同整合为评级较高的合同，将所有参与者从一份合同通常转移到 评级较高的一个，没有参赛者选择。在目标一中，本研究将把这一合同合并作为一种 衡量星级提高对参与者的可观察性和自主性的影响的外生工具 报告结果。在第二个目标中，这项研究将使用现有的受益人水平数据来了解不同的参与者 对合同的总体评级做出贡献，并评估长期患病参与者中取消投保的影响 关于未来一年的收视率。拟议的工作具有创新性，因为它结合了一组独特的数据，这些数据尚未 它采用了一种新的准实验设计来研究恒星的影响 对参与者结果的评级。拟议的工作意义重大，因为超过1800万人受益于医疗保险 依靠这些星级评级来确保他们的计划为他们提供足够的护理质量。真知灼见 从这项工作中获得的将有助于CMS改进星级评定计划和激励措施的设计 MA计划，最大限度地为所有患者提供体验。

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.