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Home   >   Resources   >   An Investigation of Medicare Advantage Dual-Eligible Member-Level Performance on CMS Five-Star Quality Measures
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An Investigation of Medicare Advantage Dual-Eligible Member-Level Performance on CMS Five-Star Quality Measures

The Centers for Medicare and Medicaid Services (CMS) evaluates Medicare Advantage (MA) health plan performance using a Five-Star Rating System based on a wide range of quality measures. MA Star Ratings are published annually, and thus influence health plan member recruitment and retention. Since 2012, the Star Ratings affect MA health plan reimbursement through quality-bonus payments made to plans that achieve higher ratings. A 2013 Inovalon study investigated the association of dual eligible populations—Medicare beneficiaries who are eligible for both Medicare and Medicaid—and the performance of MA health plans and found that dual eligible members had significantly lower scores compared to non-dual eligible members on nine of the 10 Star Measures evaluated.

The objective of this follow-up investigation was to identify the factors associated with the lower Star Ratings among dual eligible members. To our knowledge, this is the first study to use a large-scale claims database comprised of more than 2.2 million MA beneficiaries, supplemented with new detailed sources of sociodemographic and community resource data at the member-level in conjunction with monthly data on dual eligible status. This unique database enables a statistically valid evaluation of the influence of clinical, sociodemographic, and community resource risk factors on Star Measure outcomes at the individual beneficiary level.

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