Remarks on Capitol Hill Also Focus on Socio-Economic Influence on the Five-Star Rating System and Importance of Not Destabilizing the Medicare Advantage Program.
(LONG BEACH, Calif.) — The medical director of one of the nation’s largest not-for-profit Medicare Advantage plans has urged Congress to extend and make permanent the Special Needs Plans (SNP) program beyond its current 2016 expiration date so it can continue to serve the more than 1.9 million seniors currently enrolled. In accompanying remarks on Capitol Hill, she also called upon government regulators to not underestimate the impact that socio-economic factors have on the Five-Star rating system that measures the quality performance of health plans and their provider partners.
Romilla Batra, M.D., medical director of SCAN Health Plan, made her remarks at a recent meeting of the Healthcare Leadership Council. Addressing a gathering of House and Senate legislative staffs, Dr. Batra advocated strongly on behalf of Special Needs Plans, including those that focus on chronic care (such as diabetes), institutionalized care and dual-eligibles (people eligible for both Medicare and Medicaid). According to Dr. Batra, these plans “have proven to provide immense, measureable value to both the individuals themselves as well as the healthcare system as a whole.” For instance, the Chronic Disease Special Needs Plans (C-SNPs) tailor benefits and provider networks to meet an individual’s specific disease state, such as diabetes or end-stage renal disease.
“Repeated studies have shown that SNPs are doing their job, and we urge Congress to support the longer-term extension and ultimately make permanent these plans so people with special needs can get the care and attention they deserve,” said Dr. Batra. “At SCAN we have seen firsthand how appropriate care coordination, care management and disease management can lead to better clinical outcomes, reduced hospitalization, and overall better quality of life.”
Dr. Batra also discussed the current Five-Star rating system which, as of this year, determines how Medicare Advantage plans (and increasingly physicians) are paid. Health plans are graded on a one- to five-star rating based on more than 50 quality metrics, which weigh such factors as clinical outcomes, access to preventive services like screenings and vaccines, managing chronic conditions, preventive care, and consumer satisfaction. The higher the star rating, the more dollars plans receive from the federal government.
While expressing support for the Five-Star program and its emphasis on rewarding quality, Dr. Batra said that it is important to also consider “the socio-economic status of a health plans’ membership, including dual eligible, and the effect that may have on Medicare Advantage plans’ ratings.” She cited a recent study published in Health Affairs that suggested that “lower SES beneficiaries may have a negative impact on the Five-Star ratings for a Medicare Advantage plan.”
In speaking broadly about the importance of providing quality healthcare services to America’s growing senior population, Dr. Batra cautioned her audience and the elected officials that they represent on the dangers of destabilizing the Medicare Advantage program. Enrollment in Medicare Advantage plans has risen steadily over the past decade, and today nearly three in ten Medicare beneficiaries are enrolled in such plans. As a result, she urged for the stabilization of the Medicare Advantage payment structure and said that continued reductions in reimbursement to these plans combined with added layers of regulations would have the chilling effect on “destabilizing how high-value care is delivered to nearly 16 million of the nation’s most vulnerable citizens and highest utilizers of healthcare.”
Dr. Batra’s appearance on Capitol Hill was part of SCAN’s long history of advocating on behalf of seniors and senior health. Last month SCAN Chief Executive Officer Chris Wing attended President Obama’s State of the Union address and met with congressional leaders to discuss how to make affordable, high-quality care accessible to all Medicare beneficiaries. In addition, Wing and other SCAN executives have routinely testified before House and Senate Subcommittees and are published frequently on healthcare issues of national concern.
SCAN Health Plan, one of the nation’s largest not-for-profit Medicare Advantage plans currently serving 170,000 members in California. For more information on SCAN visit scanhealthplan.com or facebook.com/scanhealthplan.
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