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Unfair Advantage


Medicare Advantage rankings penalize plans serving disadvantaged populations, study finds.

New research from Brown University suggests that federal rankings of Medicare Advantage plans may unfairly penalize those that enroll a disproportionate number of non-white, poor, and rural Americans.

The study, published in Health Affairs, used data collected by the Centers for Medicare and Medicaid Services (CMS) to measure the quality of care provided in Medicare Advantage plans, and adjusted performance rankings for race, neighborhood poverty level and other social risk factors. After the adjustments, plans serving the highest proportions of disadvantaged populations improved considerably in the rankings.

Medicare Advantage is a newly popular option among Americans who qualify for Medicare, according to statistics from CMS. While patients who use Medicare Advantage are restricted to specific networks of doctors, they’re also able to compare dozens of plans and select the best one for their needs based on rankings, cost, and other factors.

CMS rankings measure a plan’s quality by examining how well its health care providers perform in about 30 categories, including customer service, efficiency in processing claims and appeals, disease screening rates and patients’ body mass indexes. The Brown researchers adjusted for socioeconomic disadvantage in just three of those categories—blood pressure control, cholesterol control, and diabetes control—and found that many lower-ranked plans suddenly moved substantially higher in the rankings.


Shayla Durfey

Shayla Durfey

Shayla Durfey MD’19 ScM’19, the study’s lead author and a student in the primary care-population medicine program at the Warren Alpert Medical School, says she and her colleagues chose to adjust the data in those three categories because previous literature has shown that disadvantaged populations disproportionately suffer from uncontrolled high blood pressure, high cholesterol levels and diabetes.

“To control diabetes, for example, you need things like good health literacy, access to healthy foods, and access to money that buys healthy foods,” Durfey says. “If you live somewhere rural and have a low-paying job, you have fewer healthy choices near you, and they’re often too expensive to consider.”

Currently, CMS rankings account for just two risk factors: dual eligibility—which indicates that someone qualifies for both Medicare and Medicaid—and disability. Durfey says that while health scholars have long debated which CMS categories should be adjusted to account for social risk, many experts agree CMS should do more.

“The adjustments CMS uses do not fully account for true measures of socioeconomic status, such as income level, education, and employment,” she says. “These factors have been shown to play a huge role in a person’s lifetime health.”

Read the full story here.


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