• Am J Manag Care · Sep 2018

    Adjusting Medicare Advantage star ratings for socioeconomic status and disability.

    • Melony E Sorbero, Susan M Paddock, Cheryl L Damberg, Ann Haas, Mallika Kommareddi, Anagha Tolpadi, Megan Mathews, and Marc N Elliott.
    • RAND Corporation, 4570 Fifth Ave, Ste 600, Pittsburgh, PA 15213. Email: msorbero@rand.org.
    • Am J Manag Care. 2018 Sep 1; 24 (9): e285e291e285-e291.

    ObjectivesStudies have identified potential unintended effects of not adjusting clinical performance measures in value-based purchasing programs for socioeconomic status (SES) factors. We examine the impact of SES and disability adjustments on Medicare Advantage (MA) plans' and prescription drug plans' (PDPs') contract star ratings. These analyses informed the development of the Categorical Adjustment Index (CAI), which CMS implemented with the 2017 star ratings.Study DesignRetrospective analyses of MA and PDP performance using 2012 Medicare beneficiary-level characteristics and performance data from the Star Rating Program.MethodsWe modeled within-contract associations of beneficiary SES (Medicaid and Medicare dual eligibility [DE] or receipt of a low-income subsidy [LIS]) and disability with performance on 16 clinical measures. We estimated variability in contract-level DE/LIS and disability disparities using mixed-effects regression models. We simulated the impact of applying the CAI to adjust star ratings for DE/LIS and disability to construct the 2017 star ratings.ResultsDE/LIS was negatively associated with performance for 12 of 16 measures and positively associated for 2 of 16 measures. Disability was negatively associated with performance for 11 of 15 measures and positively associated for 3 of 15 measures. Adjusting star ratings using the CAI resulted in half-star rating increases for 8.5% of MA and 33.3% of PDP contracts that exceeded 50% DE/LIS beneficiaries.ConclusionsIncreases in star ratings following adjustment of clinical performance for SES and disability using the CAI focused on contracts with higher percentages of DE/LIS beneficiaries. Adjustment for enrollee characteristics may improve the accuracy of quality measurement and remove incentives for providers to avoid caring for more challenging patient populations.

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