Study: Medicare Advantage ratings don’t account for system inequities
Simulated star ratings for persons with lower socioeconomic status and Black and Hispanic enrollees were substantially lower than those with higher status.
The rating system for Medicare Advantage plans fails to address racial and socioeconomic inequities, according to a study reported by the JAMA Network.
“It’s clear from this study that the way the current star ratings are constructed, they’re not capturing the full experience of all beneficiaries,” said David Meyers, lead study author and a Brown University assistant professor of health services, policy and practice. “The fact that Medicare Advantage plans can earn higher-star ratings overall even if they’re not adequately serving minority beneficiaries doesn’t provide much of an incentive to address health equity.”\
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This cross-sectional study of Medicare Advantage enrollees found that simulated star ratings for persons with lower socioeconomic status and Black and Hispanic enrollees were substantially lower than ratings for those with higher status and white enrollees in the same contract. As a result, star ratings, which are designed to reflect overall performance in a plan, are only modestly associated with quality for racial and ethnic minorities and people of lower socioeconomic status.
Researchers reached four conclusions from the study:
- First, they observed only a modest correlation of simulated star ratings when calculated for enrollees of low and high socioeconomic status and between racial and ethnic minority enrollees and white enrollees in the same contract.
- Second, contracts with higher star ratings had larger racial and ethnic disparities than did those with lower star ratings.
- Third, contracts with lower concentrations of individuals of low socioeconomic status and Black or Hispanic individuals had larger disparities and worse quality for these individuals.
- Fourth, they identified both within-plan and between-plan disparities in the quality of care in the Medicare Advantage program, as measured by the star ratings.
Although the study did not examine the reasons for these differences, Meyers said they may have to do with structural barriers, such as reduced access to providers, as well as structural racism.
His main concern is that because plans can earn high ratings — and high financial bonuses based on those ratings — despite providing inequitable care, the plans aren’t being adequately incentivized to address disparities. He said he hopes these results are motivating for plan managers.
“Right now there are about 30 different measures that are factored into star ratings,” Meyers said. “Adding a measure that judged a plan on how well they addressed disparities could create more of an incentive for plans to try to ensure that they’re providing high-quality care to all of their beneficiaries and that no group falls through the cracks.”
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