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Original Research |

Relationships Between Medicare Advantage Contract Characteristics and Quality-of-Care Ratings: An Observational Analysis of Medicare Advantage Star RatingsContract Characteristics and the Delivery of Quality of Care

Peng Xu, MS; James F. Burgess Jr., PhD; Howard Cabral, PhD; Rene Soria-Saucedo, MD, PhD; and Lewis E. Kazis, ScD
[+] Article, Author, and Disclosure Information

From Center for the Assessment of Pharmaceutical Practices, Boston University School of Public Health, and Center for Healthcare Organization and Implementation Research, Boston, and Veterans Healthcare System, Bedford, Massachusetts.

Disclaimer: The views expressed in this article do not represent those of the CMS, Boston University, or the U.S. Department of Veterans Affairs.

Note: Mr. Xu was a research analyst at Boston University when this research was conducted.

Acknowledgment: The authors thank Cynthia A. Korhonen, Department of Biostatistics, Boston University School of Public Health, for her support during manuscript preparation.

Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0332.

Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Kazis (e-mail, lek@bu.edu).

Requests for Single Reprints: Lewis E. Kazis, ScD, Professor, Health Policy and Management, Boston University School of Public Health, 715 Albany Street (T3-W), Boston, MA 02118; e-mail, lek@bu.edu.

Current Author Addresses: Mr. Xu, Dr. Burgess, and Dr. Soria-Saucedo: Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street (Talbot-West), Boston, MA 02118.

Dr. Cabral: Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, Boston, MA 02118.

Dr. Kazis: Professor, Center for the Assessment of Pharmaceutical Practices, Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street (T3-W), Boston, MA 02118.

Author Contributions: Conception and design: P. Xu, J.F. Burgess, H. Cabral, L.E. Kazis.

Analysis and interpretation of the data: P. Xu, J.F. Burgess, H. Cabral, R. Soria-Saucedo, L.E. Kazis.

Drafting of the article: P. Xu, H. Cabral, R. Soria-Saucedo.

Critical revision of the article for important intellectual content: P. Xu, J.F. Burgess, H. Cabral, R. Soria-Saucedo, L.E. Kazis.

Final approval of the article: P. Xu, J.F. Burgess, H. Cabral, R. Soria-Saucedo, L.E. Kazis.

Provision of study materials or patients: L.E. Kazis.

Statistical expertise: P. Xu, J.F. Burgess, H. Cabral, R. Soria-Saucedo.

Administrative, technical, or logistic support: P. Xu, R. Soria-Saucedo, L.E. Kazis.

Collection and assembly of data: P. Xu, H. Cabral, L.E. Kazis.


Ann Intern Med. 2015;162(5):353-358. doi:10.7326/M14-0332
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Background: The Centers for Medicare & Medicaid Services (CMS) publishes star ratings on Medicare Advantage (MA) contracts to measure plan quality of care with implications for reimbursement and bonuses.

Objective: To investigate whether MA contract characteristics are associated with quality of care through the Medicare plan star ratings.

Design: Retrospective study of MA star ratings in 2010. Unadjusted and adjusted multivariable linear regression models assessed the relationship between 5-star rating summary scores and plan characteristics.

Setting: CMS MA contracts nationally.

Participants: 409 (71%) of a total of 575 MA contracts, covering 10.56 million Medicare beneficiaries (90% of the MA population) in the United States in 2010.

Measurements: The MA quality ratings summary score (stars range from 1 to 5) is a quality measure based on 36 indicators related to processes of care, health outcomes, access to care, and beneficiary satisfaction.

Results: Nonprofit, larger, and older MA contracts were more likely to receive higher star ratings. Star ratings ranged from 2 to 5. Nonprofit contracts received an average 0.55 (95% CI, 0.42 to 0.67) higher star ratings than for-profit contracts (P  < 0.001) after controls were set for contract characteristics.

Limitation: The study focused on persons aged 65 years or older covered by MA.

Conclusion: In 2010, nonprofit MA contracts received significantly higher star ratings than for-profit contracts. When comparing health plans in the future, the CMS should give increasing attention to for-profit plans with lower quality ratings and consider developing programs to assist newer and smaller plans in improving their care for Medicare beneficiaries.

Primary Funding Source: None.

Figures

Grahic Jump Location
Figure.

Overall star ratings among for-profit and nonprofit Medicare Advantage contracts.

Star ratings are among a total of 409 contracts. The line represents the idealized normal curve, and the shaded area represents the empirical curve.

Grahic Jump Location

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