News Release

Clarity Sought for Facts on Medicare Advantage

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Four U.S. senators sent a letter to the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, calling on CMS to increase data collection on Medicare Advantage (MA) plans

JIM KAHN; jgkahn@gmail.com 
    Kahn is an emeritus professor of Health Policy, Epidemiology, and Global Health at the University of California at San Francisco and an editor at Health Justice Monitor.

Kahn told the Institute for Public Accuracy: “CMS should use its existing authority to collect, analyze, and publicize data on MA plan performance as it relates to specific plans and populations. The data now are too aggregate, too incomplete, and too delayed to do much good.

“MA plan data are delayed and poor quality for two reasons. More importantly, the MA insurers have no interest in providing prompt and high quality data, as that would empower CMS and beneficiaries to use the data to strengthen regulation––and choose traditional Medicare over MA. The second reason is technical: the complexity of producing complete and consistent data is magnified by the multiplicity and diversity of systems to contract, bill, review, deny, and pay claims. It’s a logistical nightmare. [This] complexity provides opportunities for mistakes and lower claim payouts.”

Kahn emphasized the importance of Point 6 in the senators’ letter, regarding actual financial burdens, or the “out-of-pocket obligations for specific services and cumulative over the year. Independent survey data suggest that cost-sharing in MA is high and creates financial barriers to care, but claims-based data (again, assessed by plan and population) would add important information to that. It’s frustrating and unacceptable for these data––available in claims––to be withheld from CMS and beneficiaries. 

“If taken seriously by CMS, these actions [outlined in the letter] would improve the ability of CMS to regulate Medicare Advantage and of beneficiaries to choose plans based on important metrics such as those highlighted in the letter. Yet––as Sen. Warren, her co-signers, and other progressive senators know––regulating private insurers is a losing proposition: they fail to comply effectively with legal reporting obligations and provide data that are incomplete, inaccurate, and delayed, thus inevitably undermining the regulatory process. And of course they fight the regulations that do occasionally get proposed, calling on congressional supporters (recipients of their campaign finance largesse) to rein in CMS.”