July 12, 2023
Payers | Tea Leaves
  • A new report from the Urban Institue says that the Centers for Medicare and Medicaid Services’ (CMS) quality bonus program is ineffective in many cases as it overpays Medicare Advantage organizations and needs reformThe bonus program, established by the Affordable Care Act in 2010, offers 5 percent bonus payments to Medicare Advantage contracts with ratings of four stars or higher. Despite more than half of Medicare Advantage plans receiving bonuses for high star ratings, the program has not led to plan beneficiaries receiving better care than they would in traditional Medicare plans, the report concluded. Unlike CMS’ other pay-for-performance programs, the quality bonus program does not penalize low-performing Medicare Advantage contracts to pay for better performers. The institute’s findings are in line with issues noted by others. Members of the Medicare Payment Advisory Commission and Democratic policymakers have expressed concerns about the program, including inflated scores, limited data sets, and its uselessness to consumers choosing a plan. (Articles here and here; Report here)
  • According to a new study, people with private Medicare coverage may not be getting the mental health services they need because they cannot find a psychiatrist within their plan’s network. More than half of the counties the researchers studied did not have a single psychiatrist participating in a Medicare Advantage plan. The researchers, in an article published on Wednesday in the journal Health Affairs, found that of the plans reviewed, nearly two-thirds were narrow, with fewer than a quarter of available psychiatrists in a plan’s network. The networks offered under either an Obamacare plan or Medicaid managed care were not as restrictive and included about 40 percent of the available psychiatrists, according to the study. (Article here)