An effort under the Affordable Care Act to encourage the health insurance industry to provide quality benefits to seniors is rewarding higher-rated plans with an unprecedented number of Medicare beneficiaries.
There are now 72%, or about 12 million, of the 17 million elderly in private Medicare Advantage products in a plan with a rating of four or more stars on a five-notch scale, according to a new analysis by Avalere Health, a consulting and research firm tracking the rollout of the ACA. When the rating system began five years ago, fewer than one in four seniors were in plans with four-star ratings or above.
The ranking system was created under the health law to guide seniors to cost-effective and higher-quality benefits. Under the Medicare Advantage Star Ratings program, plans are rated on such measures as cutting call waiting times as well as how well they encourage preventive care such as getting regular blood tests for diabetes.
“These results show that not only are plans improving, but beneficiaries are taking notice of quality ratings and using them to make election decisions,” Tom Kornfield, Avalere vice president, said in a statement accompanying the report.
The Medicare star ratings are part of the broader shift to turn healthcare into a retail experience. Healthcare, though, has a long way to go with ratings of doctors only just beginning under Medicare. Meanwhile, ratings of health plans that contract with state Medicaid programs for poor Americans are being developed, too.
With the Medicare star ratings, a rating of four is considered above average and a rating of five is excellent; the highest rankings give health plans a bonus payment and the ability of the insurers to tout their improvement. The number of seniors enrolled in plans with a rating of four or higher jumped from 65% in 2015 and 51% in 2014, Avalere data showed.
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Some are doing better than others. Aetna, which is poised to become a much larger player in the Medicare business should its acquisition of Humana be approved, said 87% of its members are enrolled in Advantage plans rated with four stars or higher.
Aetna says it achieved five stars across all of its Medicare plans when it came to “call center performance and two part D appeals areas.” Essentially, this means Aetna is doing a good job responding to seniors' complaints, concerns and other questions, which insurers weren’t measured on before by Medicare.
Aetna sees the ratings as improving the health of seniors. Nancy Cocozza, president of Aetna’s Medicare business, said the ratings reflect the insurer’s commitment to increasing the number of healthy days” for seniors in its plans “by working more closely with their doctors to enhance care coordination and patient satisfaction, and improving our members’ experience.”
It’s only the beginning. On a recent call with members of the Association of Health Care Journalists earlier this month, the Obama administration's top Medicare executive said measuring providers and insurers will make healthcare more like other consumer-friendly industries.
“We are moving to a more retail-healthcare world,” Andy Slavitt, administrator for the Centers for Medicare & Medicaid Services told healthcare journalists. “Nobody likes to be measured. But they will feel better about they way they are measured.”
