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Why Kill the Medicare Advantage Demo?

Margaret Dick Tocknell, for HealthLeaders Media, April 25, 2012

United has reportedly set the goal of having all of its more than two million Medicare Advantage demo members in four-star or better plans by 2014. Aetna has established a dedicated business team to drive the improvement of its performance in the stars program. And, WellPoint officials have linked the acquisition of CareMore, a Medicare Advantage plan, with its efforts to achieve higher quality star ratings.

And finally, we're talking about a paradigm shift from payment-for-volume to payment-for-quality. That takes some adjustment. The demo just makes the change a little easier. Think of it as kickstarting the quality improvement process.

According to the GAO figures, $3 million will cover increased enrollment in the Medicare Advantage demo as beneficiaries switch from fee-for-service. I thought that was the point of the program—to move beneficiaries away from the volume-based care of FFS to quality-based care.

The GAO report also notes that much of the increased Medicare Advantage demo enrollment will occur in average-rated plans, which is where most of the membership is concentrated now. But that's probably because most of the large enrollment plans such as Humana and UnitedHealth are currently three-star plans. They have no intention of staying at that position,  and will most likely take their enrollment with them as they improve their ratings.

The CMS star rating program is based on more than 40 different Medicare Part C and Part D quality measures. Information is compiled from member surveys, physicians, and CMS reports, as well as the results from regular Medicare monitoring activities.

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