Performance Scores for Dual-Eligibles Can Drag Down Medicare Advantage Ratings, Study Says

Low-income and disabled people who are dually eligible for Medicare and Medicaid and belong to Medicare Advantage plans consistently score worse than other Medicare Advantage enrollees on the performance measures that determine plan eligibility for bonus payments from the CMS, according to a new study (PDF).

The results suggest a significant association between Medicare Advantage plan performance and the socio-economic status, demographics and severity of illness of subscribers. Experts say dual-eligible beneficiaries are a uniquely challenging population to serve, given the high percentage with multiple chronic conditions including physical and mental disabilities and substance abuse issues; also, a significant percentage are homeless. Some argue that it's difficult or impossible for even conscientious health plans serving large numbers of dual-eligibles to achieve Medicare's benchmarks of quality.

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Source: Modern Healthcare