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CMS Report Shows Medicare Advantage Plan Performance and Quality Continue to Improve

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On Friday, the Centers for Medicare & Medicaid Services (CMS) released data on Medicare Advantage (MA) plan performance and quality.

“The Affordable Care Act put in place strong financial incentives to improve quality, and health plans are responding with improvements that are exceeding most expectations,” said Dan Mendelson, CEO at Avalere Health.

Avalere analyzed the data and experts are available for comment. Toplines from their analysis include:

Overall, average MA plan performance continues to improve.

The average enrollment-weighted star rating for Medicare Advantage Prescription Drug (MA-PD) plans increased to 3.92 for 2015, compared to 3.86 in 2014 and 3.71 in 2013.

Approximately 60 percent of MA enrollment is in four or five star plans, an increase from the 52 percent of MA enrollment in four or five star plans in 2014. This may reflect beneficiaries beginning to select higher quality plans as the number of contracts with four to five stars has remained stable since last year.

Eleven MA-PD contracts and two MA-only contracts received five star ratings compared to 11 MA-PD contracts in 2014 and three MA-only contracts. There are three new MA-PD contracts that are five stars this year, replacing three contracts that fell below five stars. Five of the 11 MA-PD contracts with five stars are Kaiser contracts.

Geographic variation in enrollment in higher performing plans continues.

CMS released maps for 2012-2015 showing average enrollment-weighted star ratings by county. There are almost no counties with enrollment weighted averages below three stars (Avalere Health identifies six counties, four of which are in Texas).

Consistent with last year, there is geographic variation related to enrollment in higher-quality plans with average ratings higher in northeastern states, as well as WI, MN, CA, OR, WA, and FL. County averages continue to be lower in southern states like GA, SC, AK, and TX.

Significantly fewer plans identified with the low-performing icon (LPI) from last year.

• There is significant change in the number of contracts receiving the LPI for 2015 (7) as opposed to 39 contracts that received the LPI for 2014. The LPI is used to identify plans with three consecutive years of ratings at or below 2.5 stars in either Part C and/or Part D ratings. For 2015, six contracts with the LPI were MA plans and one is a PDP contract. CMS notes that of the 39 contracts from last year with the LPI, 32 either improved, withdrew, or consolidated their contracts for 2015. And of those that did not withdraw or consolidate, 65 percent improved their ratings.

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