Some Medicare Part D contractors have an unfair advantage over other companies based on their members' socioeconomic characteristics, which substantially influence performance ratings issued by the Centers for Medicare & Medicaid Services, according to a new study published in the journal Health Affairs.
The study, which examined how much the socioeconomic composition of a Medicare Part D contractor's enrollee population influenced its performance ratings for medication adherence, found that more than one-third of the variation in adherence scores is tied to socioeconomic characteristics, including education and income.
Since more than 150 private companies contract to provide Part D benefits to Medicare members, CMS evaluates the companies based on certain performance measures, including plan enrollees' medication adherence. To determine whether those ratings are affected by socioeconomic status, the study authors analyzed 2012 data from CMS and the U.S. Census Bureau.
As a result of the findings, the study recommends that CMS "seriously consider" adjusting adherence scores to account for members' different socioeconomic characteristics. Some analysts claim such adjustments will thwart incentives to avoid enrolling people whose socioeconomic characteristics are considered factors of low performance scores. Another reason to consider adherence measure adjustments, according to the study, is that poor Part D performance ratings could hurt stand-alone drug plans if potential enrollees check CMS ratings when looking for a prescription drug plan.
The findings come as the Centers for Medicare & Medicaid Services released a whopping 678 pages of draft revisions to Medicare C and D regulations intended to fight fraud and save the program about $1.3 billion over five years, FierceHealthPayer previously reported. The proposed rule, which aims to strengthening the government's ability to weed out underperforming contractors, would clarify the scope of CMS authority to terminate Part C and D contracts when it finds an organization failed to carry out its contract with the government or has performed in a "manner inconsistent with efficient and effective administration," the rule states.
To learn more:
- here's the Health Affairs study abstract