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Member Research and Reports

Member Research and Reports

BU: Geography Influences Government Grading of Medicare Advantage Plans

Geographic location is an important predictor of the quality grades assigned to Medicare Advantage insurance plans, and the federal government should consider accounting for geographic differences to allow for fairer comparisons among plans, Boston University School of Public Health (BUSPH) researchers say in a new study.

The study in the journal PLOS ONE found that lower “star ratings” were assigned to plans in the Southeastern region of the U.S., and that many states’ ratings would rise or fall if these governmental measures adjusted for geographic differences nationally.

The rating system was instituted by the federal Centers for Medicare and Medicaid Services (CMS) as a way to make sure Medicare beneficiaries in different plans were getting high-quality care. CMS has tied financial incentives to the ratings; plans that earn at least four (out of five) stars receive a boost in reimbursement, have the option to expand as a business, and are eligible for bonuses. Indicators used in the ratings include health outcomes, access to care, patient ratings of satisfaction and other measures of quality — but not location of the plan.

“These findings suggest that the effect of geography on the plans’ ratings is not trivial, and should be considered in future comparison of plans,” says the study, led by Dr. Lewis Kazis, professor of health policy and management. Because different regions of the country have different community health characteristics and access to hospitals and providers, accounting for geography would help to “level the playing field” when comparing plans, the authors say.

To read more about the study, go to: http://www.bu.edu/sph/2016/01/12/geography-influences-government-grading-of-medicare-advantage-plans/