Medicare Advantage Star Rating of California Physician Organizations Measurement Year December 2015
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1 Medicare Advantage Star Rating of California Physician Organizations Measurement Year 2014 December 2015
2 Why Measure Medicare Advantage (MA)? IHA measures Medicare Advantage (MA) star ratings (1-5 stars) at the physician organization (PO) level, mirroring IHA s Value Based Pay for Performance (VBP4P) PO measurement for commercial HMO/POS members. As MA enrollees continue to choose high-performing plans delivering high quality care, bringing CMS s measurement efforts closer to the organizations providing care is particularly valuable. MA population growing: In California, almost 4 in 10 Medicare beneficiaries enrolled in a MA health plan, compared to 3 in 10 nationally HMOs are plan type of choice for MA enrollees: 98% of California MA beneficiaries are enrolled in an HMO plan Enrollees choosing highly rated plans: Nationally, share of enrollees in MA health plans with 4 or more stars increased from 37% in 2013 to 61% in 2015 Jacobson et al., Medicare Advantage 2015 Spotlight: Enrollment Market Update. Kaiser Family Foundation. June Integrated Healthcare Association. All rights reserved. 2
3 IHA MA Star Rating Program Evolution 2016 Integrated Healthcare Association. All rights reserved. 3
4 Medicare Advantage Enrollment in California 34 health plans cover 2.1M California Medicare Advantage beneficiaries; for comparison, commercial HMO/POS has fewer plans and more enrollees (20 health plans and nearly 9.7M members) Physician organizations contract with many MA plans for relatively small populations 2016 Integrated Healthcare Association. All rights reserved. 4
5 IHA MA Star Rating Measurement of Physician Organizations (PO) Six health plans with over 80% of Medicare Advantage enrollees in CA participate in IHA PO star rating program: Anthem Blue Cross Blue Shield of CA Health Net Kaiser Permanente SCAN Health Plan UnitedHealthcare 179 participating physician organizations 2016 Integrated Healthcare Association. All rights reserved. 5
6 Aggregation Strengthens Signal Given the fragmentation of the MA market, aggregation of a PO s performance across health plans creates a single summary of performance that is more reliable than any single health plan s estimate of the PO s performance. Each dot on the teal line represents a PO s performance across participating health plans. The red and blue lines reflect the range of plan-specific results for the same PO. For example, the identified PO has aggregated performance across contracted plans of On a plan-specific basis the PO s performance ranges from 52.7 to 81.4 the plan-specific results are more sensitive to variation in small numbers and reflect uncertainty about the PO s actual performance Integrated Healthcare Association. All rights reserved. 6
7 IHA Medicare Advantage Stars Measure Set IHA s measurement focuses on the three CMS Medicare Advantage Stars domains that are related to physician organization performance in delivering care: Staying Healthy - Screenings, Tests and Vaccines, Managing Chronic (Long Term) Conditions, and Drug Safety. Of the 22 PO-survey relevant measures that comprise these domains, IHA collects all 13 measures that do not require patient or chart review. Eight measures in the PO subset are also collected in the broader commercial HMO/POS measure set used in VBP4P (denoted by *) Integrated Healthcare Association. All rights reserved. 7
8 Calculating IHA MA PO Star Ratings 2016 Integrated Healthcare Association. All rights reserved. 8
9 Triple Weighted Outcomes Measures Results Mixed CMS triple weights outcome and intermediate outcome measures, so they contribute a higher proportion to overall stars ratings. Of the six triple-weighted measures collected by IHA, one measure saw statistically significant improvement from 2013 to 2014 (denoted by *). The average PO rate of poor blood sugar control in diabetics improved decreasing from 26.4% to 22.2%. Higher-is-better measure 2016 Integrated Healthcare Association. All rights reserved. 9
10 Improvements in Process Measures Seven measures collected by IHA are CMS single-weighted process measures. MY 2014 saw statistically significant improvement in three of these measures (denoted by *). The increased adoption and use of EHRs may partly contribute to large increase from 68.9% to 78.5% -- observed in Adult BMI Assessment. Higher-is-better measure 2016 Integrated Healthcare Association. All rights reserved. 10
11 Reduced Variation in PO Performance in 2014 Looking at three of the process measures with statistically significant improvement we see that improvements are coming from both the higher and lower performing POs. For example, in the graph below, the range of Adult BMI Assessment rates for the middle 50% of POs (i.e., interquartile range) narrowed 20 percentage points from 2013 to 2014 (from 48 to 28 percentage points). Diabetes Care: Eye Exam Adult BMI Assessment Breast Cancer Screening 2016 Integrated Healthcare Association. All rights reserved. 11
12 Performance in Commercial HMO Correlated to Medicare Advantage Performance Comparing results for POs participating in both VBP4P and MA star ratings measurement suggests performance across populations and products is closely related; the correlation between PO performance in commercial VBP4P and MA Stars is very high, ranging from for all measures collected for both populations except readmissions (not shown) Integrated Healthcare Association. All rights reserved. 12
13 Summary of PO Star Ratings When applying the annual CMS star cutpoints to PO performance, the average PO star ratings range from Triple-weighted measures (bold) generally outperform process measures. Comparing the PO average in California to the health plan average nationally, PO averages are higher for 9 of the 13 measures. Measures are ranked in order from highest CA PO star rating to lowest Integrated Healthcare Association. All rights reserved. 13
14 Overall PO Star Ratings Overall PO performance on the largely clinical subset of CMS measures collected in IHA s MA Stars program contribute to the overall CMS star ratings for health plans, for which there are strong financial and enrollment incentives Integrated Healthcare Association. All rights reserved. 14
15 Medicare Advantage California PO 5 and 4.5 Star Award Winners Six California POs earned an overall star rating of 5 the highest level of performance. An additional 56 POs earned 4.5 stars. All award winners are listed on the IHA website ( Integrated Healthcare Association. All rights reserved. 15
16 (Continued) Medicare Advantage California PO 5 and 4.5 Star Award Winners 2016 Integrated Healthcare Association. All rights reserved. 16
17 Medicare Advantage California PO Most Improved Award Winners The 28 California POs listed below increased their overall star rating by at least 1 star from 2013 to 2014, including nine POs whose performance improved by 1.5 stars Integrated Healthcare Association. All rights reserved. 17
18 Public Reporting To help Medicare beneficiaries select high-quality physician organizations, the IHA MY 2014 Medicare Advantage PO Star Ratings will be released in the Office of the Patient Advocate s Report Card: Release scheduled for early 2016 Report card features overall star ratings, as well as individual measure rates and star ratings 2016 Integrated Healthcare Association. All rights reserved. 18
19 Additional Resources Additional information on the Medicare Advantage Results for Measurement Year 2014 can be found on the IHA website at Questions may be directed to Thank you! 2016 Integrated Healthcare Association. All rights reserved. 19
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