Study investigates health outcomes of Medicare beneficiaries enrolled in MA plans at member-level

Inovalon (Nasdaq: INOV), a leading technology company providing advanced cloud-based analytics and data-driven intervention platforms to the healthcare industry and the Special Needs Plan (SNP) Alliance, released today the largest analysis ever performed on dual eligible quality outcomes, entitled "An Investigation of Medicare Advantage Dual Eligible Member-Level Performance on the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Measures." The study analysis, leveraging Inovalon's MORE² Registry^® dataset and multiple partnered healthcare organizations, found that disadvantaged beneficiaries—such as dual eligible beneficiaries covered by both Medicare and Medicaid—have worse health outcomes that cannot be attributed to a health plan's quality of service. Moreover, additional factors beyond the high-risk chronic health conditions that members present may contribute to worse health outcomes. The study findings indicate that Medicare Advantage (MA) plans serving disadvantaged beneficiaries may provide higher-quality care than their ratings reflect under the current Five-Star Rating System Medicare uses to assess the performance of plans. This is the first large-scale, independent study to investigate health outcomes of Medicare beneficiaries enrolled in MA plans at the member-level.

"This is an important, ground-breaking analysis of data not previously achievable in the industry," said Christie Teigland, Ph.D., senior director of statistical research at Inovalon and principal investigator of the study. "The study utilized Inovalon's powerful analytics platform and rich data assets together with additional partnered data, combining for the first time an array of clinical, sociodemographic and community resource data to study the observed disparities. The results show that a higher prevalence in the dual eligible population of high-risk clinical conditions, sociodemographic factors such as living in a high poverty area, and community resource factors such as living in an area with a shortage of primary care physicians, result in worse outcomes given the same access and quality of care."

"The study provides compelling evidence that quality measures in the Five-Star Rating System do not fully capture the complexity of the circumstances in which Medicare's dual eligible population lives or the complexities involved in their health care," said Richard Bringewatt, president and chair, SNP Alliance. "Performance measures must take this evidence into account for health plans to have an accurate quality rating system. Plans and providers that serve disadvantaged populations, such as MA Special Needs Plans, should also take this evidence into account as it sheds light on a range of sociodemographic factors that, if properly addressed, could help us develop and target more ways to improve health outcomes for our members."

"We've suspected all along that the poorer health outcomes of dual eligible members are not caused by the quality of plans, but are due to other factors," said Dr. Paige Reichert, medical senior director of quality, Cigna HealthSpring. "If the disparity of outcomes between dual eligible and non-dual eligible members were due to the quality of care provided by the plan, the results would have been similar between both groups. However, because the study controlled for similar member characteristics, we see that it's sociodemographic factors that are affecting health outcomes. Clearly the issues that are affecting the health outcomes of disadvantaged beneficiaries need to be addressed to eliminate health disparities, and should also be taken into account when measuring the quality of Medicare managed care plans."

Insights gained from this analysis will empower new advancements in Inovalon's patient-level and provider-level analyses technologies designed to achieve greater insight into the identification of gaps in care, quality, and financial performance, as well as the intervention platforms needed to resolve such gaps.

SOURCE Inovalon