Medicare private plans boost quality in time for bonuses

Washington Private Medicare health plans are achieving higher scores on quality measures for managing obesity and other chronic conditions, the National Committee for Quality Assurance stated in a recent report.

NCQA found that Medicare Advantage plans have made major strides on quality reporting and are outperforming other commercial plans in some instances. The nonprofit quality organization published its State of Health Care Quality Report 2012 on data reported by physicians and hospitals for about 40 measures in 2011.

Assessment of adult body mass indexes saw tremendous improvement among Medicare Advantage plans, NCQA President Margaret E. O’Kane said during an Oct. 30 briefing with reporters. The obesity measure, which was introduced in 2009, rose an average of 18 percentage points in Medicare HMOs to 68.2% in 2011, and 26 points in Medicare PPOs to 62.2%. The results show that physicians treating patients covered by those plans are paying more attention to obesity, which is an important first step toward helping beneficiaries manage their weight, O’Kane said.

“We congratulate the plans who made this a priority,” she said.

In 2012, health plans started receiving higher Medicare payments for showing improvement on quality measures. The Centers for Medicare & Medicaid Services is leading a nationwide demonstration project that rewards plans, using a star rating system.

The reward system has been criticized sharply by some in Washington. The Government Accountability Office said the Obama administration exceeded its authority by launching the project, and that the program provides little incentive for health plans to achieve higher scores.

Republicans in Congress have cited the GAO in calling for the demonstration to be shut down. Democratic lawmakers in response have said Americans are happy with Medicare Advantage, as it remains a popular option for seniors.

The NCQA report concludes that plans are responding to rewards for better performance. In some areas where quality reporting has stalled, performance had improved in the year leading up to the launch of the CMS bonuses. For instance, a measure on the use of high-risk medications among the elderly improved to a 3.6% rate from about 6% in 2010.

Health plans achieving higher scores on quality measures are aligning incentives to promote quality, said Marylou Buyse, MD, chief medical director of the Scott & White Health Plan, which operates plans in Texas. Her company has worked to provide more education on measures to physicians and offer guidance on what is needed to achieve better scores and higher payment rates through pay-for-performance programs.

For example, the plan also offers physicians feedback on managing patients who need additional screenings to manage chronic conditions. Patients also receive actionable lists to be more active participants in their care. Dr. Buyse said tracking obesity can lead to greater participation in programs, such as exercise and healthy eating classes aimed at reducing weight.

Other measures, such as one on advising smokers to quit, saw improvements, too. Medicare HMOs increased their rate to 81.5% in 2011 from 77.9% in 2010. PPOs increased slightly to 79.3%.

Private Medicare plans had lagged behind other commercial payers when measuring the persistence of beta-blocker therapy six months after a patient’s heart attack or serious cardiovascular event. However, in 2011, Medicare HMOs had a reporting rate of 87.3% for the measure, up from 65.4% in 2005. Commercial HMOs had an 81.3% reporting rate in 2011 and a 70.2% rate in 2005.

“They’ve gone from worst in the category to best,” O’Kane said.