Star Ratings Conundrum: CMS Stresses Care Quality, but Beneficiaries Stress Cost

By James Gutman - May 16, 2014 There is a kind of Catch 22 for Medicare Advantage (MA) plans and even more so for stand-alone Prescription Drug Plans (PDPs) in the findings of Kaiser Family Foundation (KFF) focus groups during last fall’s Annual Election Period about how seniors choose private Medicare plans. While CMS is pushing to make quality of care the focus of those decisions via its star-rating system, “overall it seems the star ratings are not affecting seniors’ plan choices,” Gretchen Jacobson, Ph.D., associate director, program on Medicare policy at KFF, said at a KFF briefing on the focus-group results May 13. The findings have got to be frustrating to CMS — and even to the insurers who expend huge amounts of financial and human resources to improve on the criteria the agency measures for the annual star quality ratings. This is probably especially the case for the PDPs, which do not get bonus payments from CMS for achieving high stars results the way MA plans do. While CMS has focused on the star ratings as a means by which Medicare beneficiaries can compare plans, the focus groups suggest that the seniors rely instead more on insurance agents and friends. “I’ve never used [star ratings] because I presume that they are doing some weighting of these factors to get to the stars, and my only factor that I care about is cost,” one focus-group participant told KFF. Another, referring to stars, said “I haven’t seen that, and I’m online every day and I never paid attention to that.” “Stars…have meant absolutely nothing for seniors,” asserted Barclays Capital securities analyst Joshua Raskin, who also spoke at the KFF briefing. He cited as evidence that while MA plans overall grew 8% in enrollment in the past year, top-rated (i.e., five-star) plans gained just 6.5% while three-star plans grew 12%. Rather than stars, “it’s the lowest [cost] structure that wins,” Raskin said. Why do you think the CMS star-ratings system has been so slow in catching on with seniors, and what can be done about it? Since the focus groups also showed that seniors — perhaps with good reason — find the agency’s Medicare Plan Finder difficult for comparing plan options, what can be done to help seniors choose the MA plan or PDP that objectively best meets their needs? How can seniors be persuaded to change plans as their needs change, when they seem to get more resistant to change as they get older? Is the fault in the stars — or in ourselves? http://aishealth.com/blog/medicare-advantage-and-part-d/star-ratings-conundrum-cms-stresses-care-quality-beneficiaries-st?utm_source=Real%20Magnet&utm_medium=Email&utm_campaign=40482656