National strategy recommendations

Incentivize Mental Health and Substance Use Performance in Medicare Advantage (MA)

Parity, Coverage, & Equitable Access
Topics
No items found.
social determinants of health
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Population
Older Adults
People with Intellectual & Developmental Disabilities (IDD)
People with Physical Disabilities
Coverage & Standards
Integration
Measurement-based Care
Medicare
Federal department
Health and Human Services
house committees
No items found.
senate committees
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Recommendation

The Centers for Medicare and Medicaid Services (CMS) should further incentivize performance on mental health and substance use disorder (MH/SUD) measures in the Medicare Advantage (MA) performance reward system (Star Ratings).

Background/summary

The Medicare Advantage quality bonus program provides financial incentives to Medicare health insurers based on the star ratings of their plans [1]. Depending on how Medicare Advantage plans perform on a series of quality measures, they are assigned a star rating, from one to five. A higher star rating means greater financial incentives, so performance on the measures is important for insurers’ bottom line.

Currently, Medicare Advantage has one measure specific to mental health: Improving or Maintaining Mental Health. This measure assesses how well beneficiary’s mental health needs are attended to, based on an annual survey that asks a series of questions about their mental health.Medicare Advantage also has other measures that include people with MH/SUD, although are not specific to MH/SUD. Plan All-Cause Readmissions assesses the extent to which people are quickly readmitted to the hospital after discharge, which can include factors related to MH/SUD conditions. An array of patient experience measures also cover those with MH/SUD, including GettingAppointments and Care Quickly, Rating of Health Care Quality, and CareCoordination. Plans must also report on their efforts to improve quality, which can include initiatives that impact MH/SUD.

To better address the full range of MH/SUD needs, the Improving or Maintaining Mental Health measure could be expanded to also cover addiction. The more general measures that include MH/SUD should also be disaggregated to provide separate incentives for beneficiaries with MH/SUD conditions, given the siloed history of MH/SUD care. By focusing attention onMH/SUD needs, Medicare Advantage plans will have stronger financial incentives to integrate MH/SUD care into overall health. Separate reporting of quality improvement in MH/SUD will also give health plans credit for the initiatives they implement to achieve this integration.

citations

1. Centers for Medicare and Medicaid Services. Medicare Advantage and Part D Star Ratings.  Last Updated October 6, 2022.

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