The subcommittee requested an update on the status of Medicare Advantage.
According to Centers for Medicare & Medicaid Services website, private Medicare-approved companies offer Medicare Advantage plans, sometimes called Part C or MA Plans. An eligible Medicare recipient who joins a Medicare Advantage plan will receive both Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage.
Since the Affordable Care Act, a growing number of individuals have enrolled into Medicare Advantage plans.
Dr. Mortensen provided information she researched regarding Medicare plans, Medicare recipients, and health status outcomes. During her testimony, Dr. Mortensen spoke on replacing existing metrics with better, patient-reported health outcomes. This helps Congress legislate accordingly and maintain the program’s success.
Medicare plans are currently measured on a star-rating basis, with five stars being the best possible score. The thresholds for rating plans often change throughout the year making comparisons and tracking difficult. Insurance entities marketing Medicare Advantage plans have trouble determining differences between a four or five-star plan as thresholds change. The subcommittee seemed unaware that thresholds and ratings were being changed from year to year.
“The one who is responsible for assessing the data is responsible for changing the thresholds,” said Dr. Mortensen.
“The ratings shift each year; as they top out, a lot of ratings are pulled out and additional ratings are put in,” Dr. Mortensen explained to the chair of the Subcommittee on Health, Representative Peter Roskam (IL-R), during questioning.
“If everyone is meeting the ratings, then they’re not measuring anything anymore,” as Chairman Roskam clarified with Dr. Mortensen.
“With Medicare Advantage star ratings, the goalposts are always moving. The plans don’t know the goalpost beforehand, and they are told maybe mid-way through what measures are going to be looked at and what’s considered a three-star, three-and-a-half-star, or four-star plan,” said Dr. Mortensen during questioning.
“In general, I think that as you get academics with their hands on the research, they’re able to come here and inform you here’s what we can do,” said Dr. Mortensen. “Access to data is tremendously important for researchers, but also to help inform policymakers as well.”
Dr. Mortensen’s research is not only making a difference in the Miami Business School, but is affecting Americans all over the country by trying to improve the health care quality they receive.
To read or watch Dr. Mortensen’s entire testimony to the Subcommittee on Health, please visit:
https://waysandmeans.house.gov/event/hearing-on-the-medicare-advantage-program/
