What will the new MAPD ranking system look like?

I feel that improving the ratings system is integral to Medicare reform. While costs and coverage are indeed incredibly important facets of every Advantage plan, quality of care and benefits are equally important for seniors. Relying on price alone may net a senior an affordable plan while sacrificing quality.  Unfortunately, many seniors do rely on price. According to Jaffe, over 75% of Advantage plan beneficiaries select plans with less than 3 stars.  Improving the ratings system can make seniors more aware of the quality of their Advantage plan, and possibly provide them with improved health care.  Adding the incentive to perform better could ultimately help seniors out.  However, that incentive needs to be clear and the ratings system needs to be solid.

Another part to the issue raised by Jaffe is that not all plans are rated, and not all areas boast 4 or 5 star rated plans.  By expanding the ratings system, and breaking down all the benefits and coverage associated with the plan, perhaps CMS can provide more comprehensive analyses to facilitate Advantage plan selection for seniors. At the same time, plans need the opportunity to improve their ratings and quality. Improvement should be recognized as a factor in the ratings.   Perhaps adding incentives for improvement in addition to overall rating might be helpful, although not necessarily cost-effective. By making providers accountable for their services and seniors more aware of the ins-and-outs of Advantage plans, perhaps there can be genuine improvements in the Medicare system.

At the same time, I feel that it might be difficult for the bonus system to work as it should, especially because standards of care vary across the country.  Jaffe quotes Vicki Gottlich of the Center for Medicare Advocacy, who raises the concern that a simple average score might bury a plan’s deficiencies beneath its stronger points. And is it really fair to rate a 3 star plan in say, Idaho, to a 5 star plan in Florida? How can the rating system be most effective when there are so many variables involved?

Although the new bonuses may help improve the quality of care available for Medicare, CMS must ensure that all the wrinkles in the rating system are ironed out before applying the ratings to all plans. Perhaps a better path for CMS to follow would be to improve the ratings, helping out both consumers and providers, before analyzing each Medicare Advantage plan.

1. Preferred Care

-Type: HMO

-State: New York

-Overall Score: 88.4

-5 stars in consumer assessment, prevention, and treatment

2. Kaiser Foundation Health Plan of Southern California

-Type: HMO

-State: California

-Overall Score: 88.1

-5 stars in prevention and treatment, 3 stars in consumer assessment

3. Geisinger Health Plan

-Type: HMO

-State: Pennsylvania

-Overall Score: 88.0

-5 stars in prevention and treatment, 4 stars in consumer assessment

4. Blue Cross and Blue Shield of Massachusetts

-Type: HMO

-State: Massachusetts

-Overall Score: 87.9

-5 stars in prevention and treatment, 4 stars in consumer assessment

5. Security Health Plan of Wisconsin

-Type: HMO

-State: Wisconsin

-Overall Score: 87.4

-5 stars in prevention and treatment, 4 stars in consumer assessment

6. Blue Cross and Blue Shield of Rhode Island

-Type: POS

-State: Rhode Island

-Overall Score: 87.3

- 5 stars in prevention and treatment, 4 stars in consumer assessment

7. Capital Health Plan

-Type: HMO

-State: Florida

-Overall Score: 87.2

-5 stars in consumer assessment and prevention, 4 stars in treatment

8. Kaiser Foundation Health Plan of Colorado

-Type: HMO

-State: Colorado

-Overall Score: 87.1

-5 stars in prevention and treatment, 3 stars in consumer assessment

9. Capital District Physicians’ Health Plan

-Type: HMO

-State: New York

-Overall Score: 87.1

-5 stars in consumer assessment, 4 stars in prevention and treatment

10. Tufts Associated Health Maintenance Organization

-Type: HMO

-State: Massachusetts

-Overall Score: 87.1

-4 stars in consumer assessment, 5 stars in prevention and treatment

According to an article in The Nation, we need the right health care reform for our nation to recover economically so it can prosper. The establishment of a national single-payer style healthcare reform system that expands the existing Medicare system to cover all Americans is said to be the “right reform.” The National Nurses Organizing Committee/California Nurses Association (NNOC/CNA) released a study last week that shows that if we implement this reform, it would provide a major stimulus to our economy by creating more than 2.6 million jobs and instilling $317 billion in new business and public revenues into our economy. $100 Billion in wages will be added as well to the U.S. economy.

Unemployment hit 7.2% in 2008; a 16 year high and over 2.6 million jobs were lost. The single-payer system will create the jobs we lost last year, approximately 2.6 million.

“Through direct and supplemental expenditures, healthcare is already a uniquely dominant force in the U.S. economy,” said Don DeMoro, lead author of the study and director of the Institute for Health and Socio-Economic Policy, the NNOC/CNA research arm.

“However, so much more is possible. If we were to expand our present Medicare system to cover all Americans, the economic stimulus alone would create an immense engine that would help drive our national economy for decades to come,” DeMoro said.

Healthcare in the U.S. currently accounts for $2.1 trillion in direct expenditures. Total health care spending is nearly $6 trillion. The comprehensive plan includes attributes such as universal eligibility, regardless of age, income, pre-existing conditions, and employment status; a uniform single standard of care for all enrollees which would eliminate the existing disparities in Medicare and Medicaid; and a single payer system for both funding and administration. The entire nation will have access to the same health services, costs, administrative cost burden, and eligibility requirements.

This single payer system can make significant contributions to the access of health care for all residents of the United States as well as a substantial economic stimulus in the form of new jobs and increased wages. The total cost for this system is $63 billion, which ends up being a huge percentage less than the bailouts paid for AIG and CitiGroup.