Technology company Inovalon released preliminary results of a study to better understand quality performance of dual-eligible members in Medicare Advantage plans. The study seeks to demonstrate how differences in dual-eligibles’ clinical, demographic, and socioeconomic characteristics result in worse performance on a majority of the measures evaluated

The research, “An Investigation of Medicare Advantage Dual Eligible Member Level Performance on CMS Five-Star Quality Measures,” aims to inform the ongoing debate on how best to improve upon the existing CMS Five-Star Quality Rating System.

Previous research by Bowie, Md-based Inovalon, released in October of 2013, provided insight into the phenomena of members of the duals population (those covered by both Medicare and Medicaid) performing worse than non-duals on certain quality metrics. The study, however, stopped short of exploring the underlying reasons.

This expanded analysis reveals new and detailed evidence that demonstrates how differences in dual-eligibles’ clinical, demographic, and socioeconomic characteristics result in worse performance on a majority of the measures evaluated. While the focus of the study was patient-level analysis, when aggregated to population levels, analysis revealed that duals perform significantly worse, for example, on antidepressant medication management and on all three medication adherence measures, but duals who are disabled or have alcohol/drug/substance abuse, or live in designated shortage areas for primary care physicians and mental health professionals, perform even worse on these measures when compared to other duals and non-duals.

The large-scale data allowed for stratification down to the patient level for the first time on such scale. Repeatedly made evident through the analysis was the implication of socioeconomic factors. The detailed data resulting from this study can now be used to inform policy, as well as the development of both population-wide and highly specific patient-level solutions to improve quality in socioeconomically challenging circumstances.

“These new analyses are game-changing and will influence how the industry looks at risk, quality ratings, and patient care for duals,” said Christie Teigland, PhD, director, statistical research, at Inovalon and principal investigator of the study. “Plans and providers can use these analysis results data to inform quality improvement programs aimed at the patients that need it most. For CMS, it provides evidence that socioeconomic barriers result in greater quality performance gaps, signaling the opportunity to potentially adjust Star ratings and leverage data-driven comparisons of quality across Medicare Advantage plans.”

“Working in collaboration with our clients has enabled Inovalon to conduct the largest multipayor analytical investigation into the challenges faced by those serving the dual-eligible population and provide the most comprehensive, data-driven intelligence to inform healthcare policymakers,” added Keith Dunleavy, MD, Inovalon’s CEO and chairman of the board. “We are pleased to be able to play a role in this important analysis, leveraging data to inform how best to achieve quality care.”

[Source: Inovalon Inc]