government
Medicare special needs plans fall short on reporting, study says
NEWS IN BRIEF — Posted Oct. 1, 2012
The Centers for Medicare & Medicaid Services should improve quality and performance measures reporting as well as care coordination models for Medicare special needs plans that provide coverage for patients coping with multiple chronic conditions.
About 9% of the 9 million beneficiaries eligible for both Medicare and Medicaid are enrolled in one of 322 special needs plans, which are a type of private Medicare Advantage insurance, according to a September report by the Government Accountability Office. The GAO found that patients in the plans were more likely to be younger than 65 and disabled, eligible for full Medicaid benefits, and frequently diagnosed with a chronic or disabling mental health condition. However, the report indicated that the Medicare agency lacks the information needed to hold plans accountable for patient care. The GAO recommended that special needs plans improve reporting of services provided to dual-eligible beneficiaries and release the information publicly.
The report “indicates that we still don’t have a clear picture of the quality of care beneficiaries in dual-eligible special needs plans receive,” said Rep. Henry Waxman (D, Calif.) in a statement. “To truly improve care for this population, we must be able to hold the plans accountable for the patients they serve through public reporting of more detailed quality and performance information.”
Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/10/01/gvbf1001.htm.
