Medicare Advantage Plans at Start of Data Tsunami

Submitted by Rob Wyse on Wed, 06/06/2018 - 13:24
Data Tsunami

CMS Administrator Seema Verma announced in April that the agency has released Medicare Advantage encounter data to researchers. (Encounter data are records of the health care services for which managed care organizations pay.)  It was reported that she said at the 2018 Datpalooza conference, “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.”
 
The purpose of the encounter data is to help researchers better understand care trends for seniors.  The data could create new benchmarks for patient outcomes and costs for Medicare Advantage. We believe that analysis of encounter data will have implications for Star Ratings, risk adjustment revenue, and cost of care for Medicare Advantage plans. 
 
CMS released preliminary 2015 Medicare Advantage data and more data is expected from insurers through August, with final data reports to follow. It is the beginning of the CMS releasing data on MA enrollees annually going forward. 
 
The amount of data will only grow based on Medicare Advantage enrollment.  It has been reported that Medicare Advantage enrollment has grown from 5.3 million in 2004 to 19 million people in 2017. Government payments to Medicare Advantage plans have grown from $77 billion to $200 billion-plus in the same time period.
 
Health care researchers noted that Medicare Advantage encounter data can help analysts get insight into how much value Medicare Advantage delivers. “Taxpayers deserve to know how their money is being spent, considering that Medicare Advantage plans receive substantial payments from the federal government and provide care for a significant and growing proportion of beneficiaries,” Niall Brennan, Charles Ornstein and Austin Frakt wrote in JAMA, the Journal of the American Medical Association, on March 13, 2018.
 
While taxpayers deserve to know how money is being spent, MA plan members deserve to know that data analytics can lead to better patient outcomes.
 
Based on actual encounter data we have analyzed within plans, we expect that MA plans are just at the start of a data tsunami that they must manage to meet more demanding metrics from CMS for plan performance.