While claims-level data for traditional Medicare has been available for several decades, the same light has not been shed on Medicare Advantage data, according to an opinion article published by JAMA.
Here are four takeaways from the article.
1. The authors — Niall Brennan, president of Health Care Cost Institute; Charles Ornstein, a senior editor at ProPublica; and Austin Frakt, PhD, a health economist in healthcare financing and economics and co-principal investigator of the Partnered Evidence-Based Policy Resource Center at the Boston VA Healthcare System — argue that while the Medicare Advantage program has grown to cover 19 million Americans, little insight has been provided on the value Medicare Advantage provides its beneficiaries.
2. While CMS planned to release Medicare Advantage data for research last year, CMS halted the data release in June 2017. The agency cited concerns about data quality, according the authors.
3. CMS' decision to retain encounter-level data on Medicare Advantage is "troubling for a number of reasons," the authors write, listing three thoughts:
- Since Medicare Advantage plans are largely funded by the federal government, the authors argue taxpayers should have more knowledge on how their money is being spent
- While some studies have claimed Medicare Advantage may outperform or fall short of traditional Medicare in certain aspects, the quality of Medicare Advantage compared to traditional Medicare can't be examined without proper data
- As releasing Medicare Advantage data with traditional Medicare data would provide a clearer picture of how physicians interact with the Medicare program overall, the authors said "there is a compelling argument to release these data to continue the recent advances made in transparency and open government"
4. The authors concluded the article by stating, "For the past few years, those not directly involved in running Medicare Advantage have been squinting through keyholes to make some sense of what it provides. The time to bring the program into the full light of day is long overdue."
For the full JAMA article, click here.
More articles on payer issues:
HHS proposes executive order loosening regulations on short-term plans
New Mexico denies allegations of bias in awarding Medicaid contracts: 3 things to know
2 OSF hospitals back in network with BCBS