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CMS Finds Evidence that Socioeconomic Differences within Contracts Impact Plans’ Star Ratings Measures

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In an effort to address concerns voiced by Medicare Advantage (MA) organizations and Prescription Drug Plan (PDP) sponsors that a high percentage of dual eligible (DE) or low income subsidy (LIS) beneficiaries negatively effects their Star Ratings, the Center for Medicare and Medicaid Services (CMS) recently released a report that investigates the potential effects of socioeconomic factors on plans’ Star Ratings.  In the report, CMS used 2014 Star Ratings data and 16 clinical measures to find the effect that beneficiaries with an eligibility status of LIS, DE, or Disability (including overlapping combinations between the three) have on a small subset of Star Ratings measures.

In the report, CMS uses odd ratios to determine the relationship between performance and socioeconomic factors within contracts.  CMS found that out of 16 measures of performance, 12 are negatively associated with LIS/DE status.  Similarly, 11 out of 15 are negatively associated with Disability status.  The remaining measures of performance were either positively associated or showed no significant association.  The results are mixed, but CMS found that there is evidence of differences in performance between LIS/DE and non-LIS/DE, and Disabled and non-Disabled beneficiaries within contracts.  CMS concludes that these particular socioeconomic indicators do have an effect on the small subset of Star Ratings measures that were analyzed, however the effect is small and not consistently negative.



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