RISE summarizes recent research of interest to our RISE Quality & Revenue community.

Strategies to improve MA star measures 

A new Health Affairs blog post identifies three ways to improve Medicare Advantage (MA) Star ratings measures.  

Soleil Shah, a medical student at Stanford University School of Medicine, and Eric Sun, M.D., Ph.D., an assistant professor in the Department of Anesthesiology, Pain, and Perioperative Medicine at Stanford University, write that as enrollment in MA plans rise, Star ratings will become even more important to help Medicare patients access high-quality health coverage. They believe that restructuring the Stars program may guide future policy on the most effective ways to measure the quality of health plans. Their suggestions:  

  • Use a net promoter measure to determine whether members would recommend their plans to others. This measure could replace several existing administrative measures, including customer service, getting appointments and care quickly, timely decisions about appeals, and rating of health plan measures. Shah and Sun write that reducing the administrative measures will provide a more balanced distribution of scoring among administrative, process, and outcome measures. 
  • Include risk-adjusted mortality rates in Star ratings calculations. The authors write that an estimated 10,000 elderly deaths per year could be averted if there was random reassignment of beneficiaries in the five percent of MA plans that have the highest mortality rates to any other MA plan. Star ratings should differentiate plans that achieve different rates of risk-adjustment mortality in order to provide incentives to MA plans to introduce coverage benefits that would lead to direct improvements in member health.  
  • Modify risk adjustment to include socioeconomic factors. This change would impact rankings for Star outcome measures for plans that have more disadvantaged populations.  

Read the entire blog post.  

The link between higher MA plan star ratings and quality 

Meanwhile, a study published in the February issue of Health Affairs uses data to quantify the degree to which MA plans with higher star ratings provide better care. Lead author David Meyers, assistant professor in the Department of Health Services, Policy, and Practice at Brown University School of Public Health, and his research team looked at contract consolidation to study the association between outcomes and insurer-initiated enrollee shifts to plans with higher-rated contracts. 

Researchers found that: 

  • Enrollees who experienced a one-star MA rating increased were nearly 21 percent less likely to voluntarily leave their plan to enroll in another plan or traditional Medicare. 
  • When hospitalized, MA members were 3.4 percent more likely to use a higher-quality hospital. They were also 2.6 percent less likely to be readmitted to the hospital within 90 days. 

Click here to read the study abstract. Access to the full text of the study requires a subscription. 

Telemedicine use during the COVID-19 pandemic 

New research also published in the February issue of Health Affairs finds that while the use of telemedicine skyrocketed at the beginning of the pandemic, overall medical visits dropped dramatically. The study, led by Sadiq Y. Patel, a postdoctoral research fellow at Harvard Medical School, offers insight into the use of telemedicine across specialties and conditions. 

The research team examined variations in outpatient visits among 16.7 million commercially insured and Medicare Advantage enrollees from January to June 2020. Their findings: 

  • During the pandemic, 30 percent of all outpatient visits were provided via telemedicine 
  • The weekly number of visits increased 23-fold compared to visits prior to the pandemic 
  • Across specialties, use of telemedicine ranged from 68 percent of endocrinologists to 9 percent of ophthalmologists 
  • Across common conditions, 53 percent of the telemedicine visits were for depression to 3 percent for glaucoma 

Despite the surge in use, the research team noted that the overall number of outpatient visits decreased by 35 percent during the pandemic. In addition, use of telemedicine was lower in communities that had higher rates of poverty.  

The findings on deferred care do raise alarms, study co-author Michael Barnett, M.D., MSan assistant professor in the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health in Boston, told HealthLeaders. Researchers worry that the most disadvantaged populations are likely the ones who had the most deferred care yet have the highest need to maintain continuity of care, he told the publication.  

Click here to read the study abstract. Access to the full text of the study requires a subscription.