BOWIE, Md. – October 30, 2013 – Inovalon, Inc., a leading provider of data-driven healthcare solutions, today announced the release of a research study titled “The Impact of Dual Eligible Populations on CMS Five-Star Quality Measures and Member Outcomes in Medicare Advantage Health Plans.” The study, the largest industry analysis to-date on the topic, found that a significant and growing performance gap exists between dual eligible and non-dual eligible members.
The study utilized member-level Medicare Advantage (MA) data extracted from Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®). The MORE² Registry provides visibility into the medical utilization of over 98 million unique and de-identified individuals nationwide covering more than 3.1 billion member-months of data from 2002 through September of 2013. Within this study, from the 11.8 million MA enrollees present within the MORE² Registry, Inovalon identified 1,335,709 enrollees in 2011 (16.6% dual eligible) and 1,605,644 enrollees in 2012 (16.2% dual eligible) from 80 individual Centers for Medicare and Medicaid Services (CMS) contracts who met the study inclusion criteria. Rates for nine Star measures were calculated independently for the dual and non-dual eligible members and then within each of those groups stratifying by various demographic, clinical, and socioeconomic characteristics. In addition a tenth measure, plan all-cause readmission rate (PCR) was calculated using the National Committee for Quality Assurance (NCQA) risk adjustment model for MA members age 65 and older, which controls for chronic conditions and factors impacting likelihood of readmission.
The study found that a significant association exists between dual eligible status and lower performance on specific Part C and D measure Star ratings. The results validate the integral role that income, race/ethnicity, and gender play on the HEDIS® and CMS Part D measures used in the Five-Star rating system. As evidenced by this analysis, the gap has widened in reported Star ratings for 2012 and 2013 compared to previous findings. When scored by either the Charlson Comorbidity Index or CMS MA risk score, dual eligible members were found to be consistently more complex to manage. Additionally, examination of 80 CMS MA contracts indicated that dual eligible members performed worse on nine of the ten Star measures that were investigated. Further, multivariate analyses controlling for demographics, socioeconomic characteristics, and severity of illness confirm dual members consistently underperform in eight of the ten measures investigated. This is an important finding demonstrating a significant performance gap exists between dual eligible and non-dual eligible members even after adjusting for other important socioeconomic and clinical risk factors. These findings suggest that the Five-Star rating system, in its current state may penalize MA plans serving a high proportion of dual eligible beneficiaries. Lower Star ratings result in lower incentive payments and may lead to reduced services to dual eligibles suggesting a need for further research into the benchmarking and refinement of Star quality measures to assure fair comparisons of performance across MA plans serving different populations.
“In today’s healthcare arena, health plans face a myriad of challenges to achieve improved quality outcomes,” said Paige Kilian, M.D., Vice President of Clinical Analytics of Inovalon. “This study is meant to provide new information that can support the leaders in the healthcare industry, and it is our hope that light is shed on the obstacles that health plans may face and that it helps to inform future discussions that will improve quality outcomes and care.”
To access the full study please click here
About Inovalon, Inc.
Inovalon, Inc. is a leading technology-enabled healthcare solutions provider focused on the importance of healthcare data and its ability to drive dramatic, objective improvement in clinical and quality outcomes, care management and financial performance throughout the healthcare community. Proprietary healthcare datasets, aggregation and analysis capabilities, combined with a national infrastructure of leading-edge technology, clinical prowess and deep human resources, empower Inovalon’s advanced generation of healthcare assessment and improvement through highly informed solutions. Driven by data, Inovalon uniquely identifies gaps in care, quality, data integrity and financial performance—while also bringing to bear the resources to resolve them. This differentiating combination provides a powerful capability suite, touching more than 540,000 physicians, 220,000 clinical facilities and more than 120 million Americans, driving high value impact and improving the quality and economics for health plans, hospitals, physicians, patients and researchers. Please visit www.inovalon.com for more information.
Kim E. Collins
4321 Collington Road
Bowie, Maryland 20716
Feinstein Kean Healthcare, on behalf of Inovalon, Inc.