GAO to CMS: Look at Health Status of Medicare Advantage Disenrollees

Sicker Medicare Advantage (MA) enrollees are more inclined to opt out of the program than healthier enrollees, according to a GAO report. And that’s something that CMS might want to consider keeping track of. Researchers looked at 35 MA plans that had higher than average disenrollment rates. Beneficiaries in poor health were 47% more likely to leave their plans than healthier members.

The report points out that CMS does not look at the health status of MA beneficiaries who disenroll. “Our analysis identified 35 contracts in 2014 where MA beneficiaries in poor health were more likely to disenroll than those in better health,” the report states. “These contracts with health-biased disenrollment had quality scores that were consistently and substantially below the scores of contracts without health-biased disenrollment.”

The information is right there should CMS decide to use it, but the agency so far hasn’t. The GOA report states that “by not leveraging it as part of its routine oversight of MA contracts, CMS is missing an opportunity to better target its oversight activities toward MA contracts that may not be adequately meeting the health care needs of all beneficiaries, particularly those in poor health.”

It is perhaps easy to predict what the GAO suggests CMS do: “[R]eview data on disenrollment by health status and the reasons beneficiaries disenroll as part of the agency’s routine monitoring efforts.”

Source: Government Accountability Office