- Center on Health Equity & Access
- Clinical
- Health Care Cost
- Health Care Delivery
- Insurance
- Policy
- Technology
- Value-Based Care
Performance Scores for Dual-Eligibles Can Drag Down Medicare Advantage Ratings, Study Says
Low-income and disabled people who are dually eligible for Medicare and Medicaid and belong to Medicare Advantage plans consistently score worse than other Medicare Advantage enrollees on the performance measures that determine plan eligibility for bonus payments from the CMS.
Low-income and disabled people who are dually eligible for Medicare and Medicaid and belong to Medicare Advantage plans consistently score worse than other Medicare Advantage enrollees on the performance measures that determine plan eligibility for bonus payments from the CMS, according to a new study (PDF).
The results suggest a significant association between Medicare Advantage plan performance and the socio-economic status, demographics and severity of illness of subscribers. Experts say dual-eligible beneficiaries are a uniquely challenging population to serve, given the high percentage with multiple chronic conditions including physical and mental disabilities and substance abuse issues; also, a significant percentage are homeless. Some argue that it's difficult or impossible for even conscientious health plans serving large numbers of dual-eligibles to achieve Medicare's benchmarks of quality.
Read the full story here: http://bit.ly/1esoW8R
Source: Modern Healthcare
Trump Administration’s Message to Supreme Court Puts New Wrinkle in Braidwood Case
February 21st 2025The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.
Read More
Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
Listen
5 Key Health Care Moments During President Trump's First Month Back in Office
February 21st 2025President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.
Read More
Same-Day Breast Imaging Gaps Reveal Health Care Disparities
February 18th 2025For this retrospective study, the authors examined data on more than 3 million screening mammographies for more than 1 million female patients; of the screenings, 23.6% had abnormal results and only 6.7% were recommended for biopsy.
Read More
