As Medicare Advantage (MA) plans enroll more and more patients with serious illness, it is not clear how well the plans take care of these patients, Mount Sinai researchers wrote in a Perspective piece recently published in the New England Journal of Medicine.
Mount Sinai researchers are sounding the alarm about the lack of data on MA quality of care and supplemental benefits as the program continues to grow in popularity in all populations. But they are especially concerned about insufficient data that may widen disparities among the fastest growing populations: Latino and Black older adults and dual eligibles (those who qualify for both Medicare and Medicaid).
The Mount Sinai team wrote in the New England Journal of Medicine that despite the program’s substantial growth, there isn’t sufficient data to evaluate the quality of care that MA members with serious illnesses receive nor is there information to assess disparities based on race, region, or dual-eligible status.
For three consecutive years, the Medicare Payment Advisory Commission (MedPAC) has stated that it cannot provide accurate descriptions of care quality. While some data has been released, they are both incomplete and unreliable. More needs to be done to cull meaningful data, researchers said.
“With Medicare Advantage growing disproportionately among Black and Latino beneficiaries, there is strong cause for concern that any quality deficiencies in the program will widen and reinforce the racial and ethnic disparities in quality of care that we have been working so hard to address,” said first author Claire S. Ankuda, M.D., MPH, assistant professor, geriatrics and palliative medicine, Icahn School of Medicine at Mount Sinai, in an announcement.
Information is also lacking on supplemental benefits, which are important to members with chronic illness who require nonmedical assistance in the form of meals, transportation, and caregiver benefits. The research team said information is needed on the frequency with which plans offer these benefits, who they are offered to, how they are delivered, and their effects on quality of care and beneficiary experience.
“Next October, we will see a critical turning point for Medicare as it will be the first time that Medicare Advantage has truly dominated, with more than half of enrollment,” said Dr. Ankuda. “With our analysis, we are hoping to plant a seed early among families who will enroll for the first time in Medicare or prepare to make important plan choices.”
MA plans have received criticism for rigid provider networks and prior authorization requirements. Detailed and up-to-date information on provider networks is necessary, researchers wrote, so beneficiaries can understand differences among plans and choose a plan that works with their preferred providers.
Ankuda also said the quality bonus program (QBP), which offers incentives to plans for high-quality care, needs strengthening and accountability. “I worry that the QBP is not capturing the voices of adults with serious illness. If the program is not hearing from these adults, or factoring in their experiences, the accuracy of their reporting has a true missing piece,” Dr. Ankuda said.
The authors outline several strategies for improvement, including:
- Congress could take action to commission a report from the National Academies of Sciences, Engineering, and Medicine on quality of care in MA.
- The National Institutes of Health could prioritize research on care delivery.
- The Centers for Medicare & Medicaid Services, which runs the Medicare Compare website, could and should publish encounter data, and require data on supplemental benefits.
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