A group of nine academic medical professionals has expressed concern about the level of care for enrollees in Medicare Advantage plans with serious illness.
In the May 11 issue of The New England Journal of Medicine, the group warned that MA plans’ financial incentives to contain costs “may undermine the ability” of those with serious illness, “who often require extensive care provided in multiple settings,” to receive necessary or high-quality care.
The group — made up of medical leaders from Harvard Medical School, Brown University School of Public Health, Icahn School of Medicine at Mount Sinai and other institutions — also questioned the lack of data available to evaluate the quality of care given to beneficiaries with serious illness by MA plans.
“For three consecutive years, the Medicare Payment Advisory Commission (MedPAC), on which one of us recently served, stated that it ‘can no longer provide an accurate description of the quality of care in [Medicare Advantage],’” they wrote, referring to MedPAC member and author David Grabowski, PhD.
In their essay, the group discussed MA plans’ appealing supplemental benefits, which are traditionally nonmedical and include home care, transportation, meal delivery and adult day care. Some 1,375 MA plans are providing in-home support as a supplemental benefit in 2023, according to an analysis. However, it is not entirely clear which plans offer what benefits, the group said.
“Information 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 isn’t available,” they said.
And the authors pointed to flaws in the quality bonus program (QBP), which offers incentives for providing high-quality care in MA. The QBP is a five-star rating system in which MA plans are scored. MA plans receive financial rewards for performing well and beneficiaries use the ratings when choosing their plan.
“A decade after the QBP’s implementation in 2012, however, concerns about its accuracy in measuring quality and its ability to drive quality improvement have been persistently documented in academic research and MedPAC reports,” the group said.
The medical leaders stressed the importance of prioritizing data transparency and quality measurement for MA plans. They shared several strategies that could address concerns with MA plans, including urging the National Academies of Sciences, Engineering, and Medicine and the National Institutes of Health to conduct research on MA care delivery. They also suggested the Centers for Medicare & Medicaid Services could clear up data on MA plan ownership.
“CMS could also start publishing data on plan ownership and take steps to make encounter data more complete, as well as require accurate reporting on networks and the delivery of supplemental benefit,” they said.
