CMS Proposes Policy on Outcome Measures Used to Assess Performance
February 22, 2016
Policy changes announced by the Centers for Medicare & Medicaid Services (CMS) governing payment methodologies for health plans and prescription drug benefits will improve the outcome measures being used to assess performance in the Medicare program.
- Revise the risk-adjustment model used to determine payment to better account for sicker, higher-need beneficiaries. As a result, Medicare Advantage plans serving dual-eligible beneficiaries would see an increase in payments
- Refine a subset of the Star Ratings program measures to account for beneficiary socioeconomic and disability status
The new CMS proposal would result in a more accurate assessment of the quality of care provided.
HAP has strongly advocated that CMS make changes to the outcome measures used to assess health care provider performance for public reporting and pay-for-performance programs, to adjust for sociodemographic and socioeconomic factors.
This proposal represents a positive step; additional work is needed to establish a more comprehensive approach to socioeconomic adjustment for all quality performance programs.
Comments on the proposed Advance Notice of Methdological Changes for Calendar Year 2017 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2017 Call Letter must be submitted by March 4, 2016. The final 2017 Rate Announcement and Call Letters will be published by Monday, April 4, 2016.