Mount Sinai Researchers Describe Urgent Need for Data on Quality of Care Offered by Medicare Advantage Plans
Analysis and Recommendations Put Forth in New England Journal of Medicine
As Medicare Advantage plans enroll more and more patients with serious illness, it is not clear how well the plans take care of these patients, Mount Sinai researchers say in a Perspective piece published today in the New England Journal of Medicine.
Medicare Advantage, the privately operated alternative to traditional Medicare, has been growing in popularity among all populations, but fastest among Latino and Black older adults and those who qualify for both Medicare and Medicaid, known as “dual-eligibles.” Medicare Advantage currently enrolls 48 percent of Medicare beneficiaries and is expected to account for approximately 60 percent of beneficiaries by 2030.
“Next October, we will see a critical turning point for Medicare as it will be the first time that Medicare Advantage has truly dominated, with more than half of enrollment,” says first author Claire S. Ankuda, MD, MPH, Assistant Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai. “With our analysis, we are hoping to plant a seed early among families who will enroll for the first time in Medicare or prepare to make important plan choices.”
Medicare Advantage plans come in many types, but all are required to cover both Part A, hospital insurance, and Part B, medical insurance. However, they can, and do, create barriers to services through various restrictions. “Doctors and patients alike are often critical of Medicare Advantage due to rigid provider networks, requirements for prior authorizations, and the overall structure of the plans which can be confusing,” says Dr. Ankuda.
“With Medicare Advantage growing disproportionately among Black and Latino beneficiaries, there is strong cause for concern that any quality deficiencies in the program will widen and reinforce the racial and ethnic disparities in quality of care that we have been working so hard to address,” says Dr. Ankuda.
Some highlights of Dr. Ankuda’s analysis:
- For beneficiaries with serious illness, there aren’t sufficient data to evaluate quality of care. For three consecutive years, the Medicare Payment Advisory Commission (MedPAC) has stated that it cannot provide accurate descriptions of care quality. While some data have been released, they are both incomplete and unreliable. More needs to be done to cull meaningful data.
- Information is lacking on supplemental benefits. Such benefits are of great importance to those with chronic illness who require nonmedical assistance in the form of meals, transportation, and caregiver benefits.
- Additionally, the quality bonus program (QBP), which offers incentives for high-quality care, needs strengthening and accountability. Implemented a decade ago, the QBP continues to face questions about its accuracy in quality measurement. Says Dr. Ankuda, “I worry that the QBP is not capturing the voices of adults with serious illness. If the program is not hearing from these adults, or factoring in their experiences, the accuracy of their reporting has a true missing piece.”
The authors outline several strategies for improvement, including action by Congress, which could commission a report from the National Academies of Sciences, Engineering, and Medicine on quality of care in Medicare Advantage.
The National Institutes of Health could prioritize research on care delivery.
And, more immediately, the Medicare Compare website would benefit from clearer context. The Centers for Medicare and Medicaid Services, which runs the website, could and should publish encounter data, as well as requiring data on supplemental benefits, the researchers said.
About the Icahn School of Medicine at Mount Sinai
The Icahn School of Medicine at Mount Sinai is internationally renowned for its outstanding research, educational, and clinical care programs. It is the sole academic partner for the
eight member hospitals* of the Mount Sinai Health System, one of the largest academic health systems in the United States, providing care to a large and diverse patient population.
Ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges, Icahn Mount Sinai has a talented, productive, and successful faculty. More than 3,000 full-time scientists, educators, and clinicians work within and across 34 academic departments and 44 multidisciplinary institutes, a structure that facilitates tremendous collaboration and synergy. Our emphasis on translational research and therapeutics is evident in such diverse areas as genomics/big data, virology, neuroscience, cardiology, geriatrics, and gastrointestinal and liver diseases.
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A culture of innovation and discovery permeates every Icahn Mount Sinai program. Mount Sinai’s technology transfer office, one of the largest in the country, partners with faculty and trainees to pursue optimal commercialization of intellectual property to ensure that Mount Sinai discoveries and innovations translate into health care products and services that benefit the public.
Icahn Mount Sinai’s commitment to breakthrough science and clinical care is enhanced by academic affiliations that supplement and complement the School’s programs. Through Mount Sinai Innovation Partners (MSIP), the Health System facilitates the real-world application and commercialization of medical breakthroughs made at Mount Sinai. Additionally, MSIP develops research partnerships with industry leaders such as Merck & Co., AstraZeneca, Novo Nordisk, and others.
The Icahn School of Medicine at Mount Sinai is located in New York City on the border between the Upper East Side and East Harlem, and classroom teaching takes place on a campus facing Central Park. Icahn Mount Sinai’s location offers many opportunities to interact with and care for diverse communities. Learning extends well beyond the borders of our physical campus, to the eight hospitals of the Mount Sinai Health System, our academic affiliates, and globally.
* Mount Sinai Health System member hospitals: The Mount Sinai Hospital; Mount Sinai Beth Israel; Mount Sinai Brooklyn; Mount Sinai Morningside; Mount Sinai Queens; Mount Sinai South Nassau; Mount Sinai West; and New York Eye and Ear Infirmary of Mount Sinai.
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties.