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An Investigation of Medicare Advantage Dual Eligible Member Level Performance on CMS Five-Star Quality Measures

March 31, 2015

Industry's largest ever analysis of dual eligible member data sheds light on nation's highest cost and vulnerability patient population.

Inovalon’s comprehensive Dual eligibles study provides insights into how clinical, sociodemographic and community resource characteristics impact health outcomes and Medicare Advantage (MA) plan Five-Star ratings. The findings provide detailed information about which member characteristics most affect quality measures to support development of population-wide and highly-specific patient-level solutions to improve quality when serving populations with challenging sociodemographic and community resource risk factors.

As the first large-scale, independent study to investigate health outcomes of Medicare beneficiaries enrolled in MA plans at the member-level, our research revealed 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 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.

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An Investigation of Medicare Advantage Dual Eligible Member Level Performance
An Investigation of Medicare Advantage Dual Eligible Member Level Performance

The objective of this investigation is to better understand the factors underlying poor performance of dual...