Avalere Health
October 19, 2011
According to a new Avalere Health analysis of the Centers for Medicare and Medicaid Services’ (CMS) landscape file of the 2012 Medicare market, a high number of prescription drug plans (PDPs) eligible for auto-assignment of low income subsidy (LIS)-eligible beneficiaries will see a drop in their star ratings from 2011 to 2012. In 2012, 52 percent of LIS-eligible plans are rated 2 stars compared to only 3 percent in 2011. In 2011, 83 percent were rated 3 stars and 14 percent were rated 4-5 stars. In 2012, 43 percent are rated 3 stars, and only 5 percent are rated 4-5 stars.
Avalere Health attributes this precipitous decline in star ratings to the new rating system established by CMS for 2012. The new system places a greater emphasis on clinical outcome measures like medication adherence. Previous year ratings emphasized more process-oriented measures such as how long a person was kept on hold when calling a plan for assistance. Moreover, unlike the Medicare Advantage program, which rewards plans with higher payments for achieving higher ratings, there is no payment incentive in Medicare Part D.
http://www.avalerehealth.net/wm/show.php?c=&id=890
Comment:
By Don McCanne, MD
We can only speculate as to why there was a very dramatic decline in the star ratings earned by Medicare prescription drug plans serving low income subsidy (LIS)-eligible individuals.
Was it because the plans simply don’t care about this low income population as long as they get their business?
Was it because there is no financial reward for Part D plans receiving higher star ratings?
Was it because of the change in the measurements of a new rating system? If so, that would confirm the findings of other studies that have shown that when efforts are made to improve results on measured processes or outcomes (“teach to the test”), then less attention is paid to those processes and outcomes which are not measured. Suddenly adding in measurements of neglected processes and outcomes would certainly cause star ratings to plummet.
Regardless of the explanation, we pay far more for the private sector to manage these plans, while our choices in products and providers are restricted, and value is diminished by the diversion of funds to these intrusive intermediaries that provide worthless services. They really do care only about their investors and not about us. It’s time to replace them and the rest of the wasteful intermediaries with our own publicly-administered, improved Medicare for all.