ACHP Issue Brief Shows Diabetes Care Improving Among Medicare Advantage Plans; Quality Gap Remains

WASHINGTON, D.C. Between 2002 and 2005, Medicare Advantage (MA) health plans improved care for Medicare beneficiaries with diabetes on each of the six HEDIS® Comprehensive Diabetes Care performance measures, according to an issue brief released today by the Alliance of Community Health Plans (ACHP).

On average, performance improved six percentage points across the measures (Chart 1).  Despite the progress, substantial variation in performance remains, particularly between the highest and lowest scoring plans, and opportunity for improvement exists even for the highest performing plans.

The issue brief, Quality of Diabetes Care in Medicare Advantage, uses publicly available HEDIS® data from the Centers for Medicare and Medicaid Services (CMS) to compare MA plans’ overall performance on diabetes care for the years 2002 and 2005, and to demonstrate how plans performed on specific measures over the four-year period.  For nearly a decade, MA plans have reported their performance on an increasingly comprehensive set of clinical quality measures to CMS.

MA plans at the top of the distribution on one diabetes measure tended to score high on the other diabetes measures. Plans at the bottom of the distribution on one measure tended to perform poorly on others.

“The systemic nature of high performance seen in the data tells us that high performance is not random. High-performing plans invest in the systems needed to provide quality care,” said ACHP president and CEO, Jack Ebeler.

The brief concludes that performance measurement and reporting have helped improve diabetes care among MA plans, but have not closed the quality gap.

“We need to do more to improve care and eliminate the quality gaps among plans.  By compensating high and low quality MA plans in the same manner, Medicare does little to recognize investments in quality and chronically low-performing plans are not held accountable,” noted Ebeler. “Retooling the payment system to align payment with quality would help improve care for Medicare beneficiaries,” Ebeler added.

A report released earlier this month by the Institute of Medicine, “Rewarding Provider Performance: Aligning Incentives in Medicare,” says Medicare providers should participate in pay-for-performance as soon as possible, and notes that Medicare Advantage plans could begin immediately.

“Implementing a payment system based, in part, on quality would begin to recognize and reward MA plans that are investing in quality, help drive improvement among low scoring plans, and encourage top plans to maintain their quality gains,” according to the ACHP brief.

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About ACHP

ACHPis a leadership organization that brings together innovative health plans and provider organizations that are among America’s best at delivering affordable, high-quality coverage and care to their communities. Drawing on years of experience, members collaborate to share strategies and work toward solutions to some of health care’s biggest challenges. Their work is the foundation for ACHP’s advocacy on behalf of better health care nationally.  More information is available at