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Medicare Advantage Data Transparency Can Enhance Insights

Increasing Medicare Advantage data transparency can help payers and healthcare experts answer necessary questions about the cost and quality of the Medicare Advantage program.

Medicare Advantage data transparency enhances consumer, researcher insights

Source: Thinkstock

By Thomas Beaton

- Expanding Medicare Advantage data transparency may allow researchers to gain more comprehensive insights into cost and quality within the popular MA program.

Healthcare experts and academic organizations currently have limited Medicare Advantage data access related to patient outcomes, CMS spending, and payer operational costs within MA. However, new federal changes could soon update available MA data.

CMS Administrator Seema Verma announced that the agency will expand Medicare Advantage data transparency for consumers and researchers to create informed opinions on the program.

The agency will share 2015 MA data related to healthcare service cost, provider information, and the setting of performed healthcare services. CMS also announced plans to release new MA data on an annual basis.  

Researchers will need this regularly updated Medicare Advantage data to answer critical questions about the MA program without relying on outdated claims information.

Why researchers need Medicare Advantage data

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A JAMA commentary from the Health Care Cost Institute, the VA, and ProPublica explained that transparent Medicare Advantage claims would help analysts understand how much private payers charge the federal government to sponsor MA plans.

The authors also argue that there is not enough information about Medicare Advantage care quality because researchers only have limited HEDIS information about preventive care in MA.

“Despite the important and increasing role of Medicare Advantage plans, there is fairly little insight into the relative value Medicare Advantage provides to beneficiaries or the funder, the US taxpayer,” the commentary authors said.

“This is attributable mainly to a lack of access to comprehensive claims or encounter-level data regarding the Medicare Advantage program for researchers, or even more aggregated information that could be made available to the general public.”

The American College of Physicians (ACP) agrees that access to modernized Medicare Advantage data would reduce waste and burden in MA while increasing quality.

READ MORE: How Payers Can Add More Value to Medicare Advantage Health Plans

Update MA data would also address alarming estimates that suggest only 85 percent of MA funding supports beneficiary care, the ACP says. The organization stressed that transparent claims data could provide a more accurate assessment of how payers fund benefits.

“As enrollment in Medicare Advantage plans increases there is a growing interest in understanding the differences in care delivery, quality, resource utilization, and cost between MA and traditional Medicare,” said Jack Ende, MD, MACP, president, ACP.

New updates may improve publicly-accessible Medicare Advantage data

Adding updates to publicly accessible Medicare Advantage datasets would allow consumers and researchers to develop insights with relevant MA data instead of outdated information.

The Research Data Assistance Center (ResDAC), a private contractor for CMS, provides public information about all CMS programs, including Medicare Advantage. CMS-approved researchers can currently access research identifiable files (RIFs), and limited data sets (LDSs). Both researchers and consumers can review public-use files.

Public use files contain aggregate, non-identifiable information so that the average consumer can understand Medicare Advantage trends. However, the data within these files are sometimes four or five years old and require an extensive update.

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For example, the Medicare Compare dataset provides users 2014 data to compare the costs of services across healthcare settings. Consumers planning healthcare purchases in the present year may not find much value in an outdated cost comparison tool.

RIFs and LDSs are less likely to have outdated datasets and claims information since ResDAC provides routine updates to these sets.  

RIFs contain identifiable information such as birth dates, age, race, gender, and geographic location that is allowable under HIPAA.  Approved RIF researchers may also request information about MA plan characteristics such as information about benefits packages and cost sharing details.

LDSs may help researchers gain significant insights in the Medicare Advantage program but is only available for select analysts.

An LDS called the Medicare Current Beneficiary Survey (MCBS) collects enrollment, utilization, payment, and copayment data within MA. The MCBS currently uses 2015 data and will have updated data at the end of 2018.

New data could confirm observable trends in the Medicare Advantage program

The Commonwealth Fund argued that Medicare Advantage program may be spending more than the amount needed to provide benefits and that updated data is needed to confirm the pattern.

The team reviewed 2014 data related to Medicare Advantage spending and found that CMS paid MA HMO plans 12 percent more than their expected per enrollee costs.

The team ultimately found that more data is needed to confirm cost and spending trends in MA, which could help address how CMS focuses payments across all Medicare programs.

“More data should enable better analysis of these issues and the focus should be on improving both MA plans and traditional Medicare, to the benefit of all Medicare beneficiaries,” the Commonwealth Fund asserted.

Administrator Verma recently emphasized a need to provide researchers and consumers greater access to CMS data in order to drive changes in value-based care. She proposed that new changes in Medicare Advantage data transparency could drive changes to help stakeholders increase their understanding of the program.

“We recognize that the MA data is not perfect, but we have determined that the quality of the available MA data is adequate enough to support research,” Verma said.

“Publicly available Medicare Advantage data should likely help consumers, stakeholders, and health plans address proposed questions related to how MA allocates health plan payments, drives quality, and creates a return on investment for CMS.”


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