Evaluating for-profit and not-for-profit medicare advantage plans based upon the star ratings: does quality of care differ?
Embargo Date
Indefinite
OA Version
Citation
Abstract
Over the past several decades, there have been enormous efforts by health care professionals to measure and improve the quality of care. Since 2008, the Centers for Medicare and Medicaid Services (CMS) has assigned Medicare Advantage plans a rating of 1 to 5 STARs based on certain quality measures. Beginning in 2012, under the Patient Protection and Affordable Care Act (PPACA), plans with 4 or higher STARs will receive bonus payment, whereas low performance plans will face reimbursement and enrollment restrictions. Organizational characteristics of Medicare Advantage plans vary by tax status. For-profit plans may or may not provide better quality of care than not-for-profit plans.
This study investigates whether health plan characteristics are associated with quality of care as indicated by the Medicare Advantage STAR ratings. We are interested in comparing for-profit and not-for-profit plans. We conducted a cross-sectional observational study to compare the STAR ratings between for-profit and not-for-profit contracts in 2010. Our study sample included 409 (72%) of total 575 Medicare Advantage contracts, which covered 10.56 million Medicare beneficiaries (90% of the Medicare Advantage population) in 2,872 counties across the United States.
In our two analytic models, the dependent vatiables were the STAR ratings. In the first model, we applied a multivariate linear regression. The independent variables included tax status, contract age, contract types, operating area, and enrollment at contract level. In the second model, we introduced a mixed effects model to address geographic variation. The individual-level independent variables included tax status, contract age, contract types, and enrollment at county level; the group-level independent variable was the geographical location (county) where the Medicare Advantage contracts operated.
Tax status was strongly associated with STAR ratings. On average, not-for-profit contracts received 0.65 more STARs than for-profit contracts (p<0.0001, 5% Cl= [0.52, 0.78]). In the regression model, the STAR difference declined from 0.65 to 0.55 but remained statistically significant (P<0.0001, 95% Cl= [0.43, 0.67]). In the mixed effects model, the adjusted difference was 0.6 (P<0.0001), exceeding the 0.55 difference from the regression model.
Tax status is important in understanding the Medicare Advantage STAR ratings. In 2010, not-for-profit contracts received higher STAR ratings than for-profit contracts. Larger, well-established (older) and not-for-profit Medicare Advantage plans appear more likely to receive higher STAR ratings than plans with other structural characteristics. When comparing plans in the future, the CMS may give attention to stratify plans based on their organizational characteristics.
Description
Thesis (M.S.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.