Millions of seniors have worried that federal health reform would eliminate Medicare Advantage, the popular plans that offer perks like gym memberships but cost the government more than standard Medicare.
Advantage plans survived, but a study says most of their customers — especially in Florida — aren't getting top-rated service. Nor can they, at least yet.
Of the more than 80 Advantage plans offered to Medicare beneficiaries in Hernando, Hillsborough, Pasco and Pinellas counties, nearly all rated between 2.5 to three stars on a government quality scale of five stars. One star is "poor;'' five is "excellent." No local plans rated four or five stars.
Expect that to change soon: Under the health reform, companies whose plans score four or five stars can get more money from the government, and advocates say that will prompt companies to improve.
Until now, the government ratings were mostly a consumer service. Stars are awarded based on factors such as how often members received various screening tests, vaccines and other preventive services; how well the plan manages members' chronic conditions; and how well the plan handles customer service issues. The information comes from sources such as member surveys and information from clinicians.
More than 10 million Americans, including about 1 million in Florida, receive Medicare benefits through Advantage plans.
A recent study by Avalere Health, a major consulting firm, found that just 23 percent of beneficiaries were signed up in plans that rate four or five stars.
The government pays Advantage companies a set amount of money per enrollee, about $10,000, which is more than it spends on a traditional Medicare beneficiary. That allows companies to offer additional benefits like gym memberships or rebates of monthly premiums.
Though Advantage companies face cuts next year, those reductions could be offset with the bonuses given to companies with plans rating four stars or higher.
Of the 349 Advantage plans in Florida, only 11 rated four stars and just two rated five stars. The five-star plans are from Capital Health Plans, which serves the Tallahassee area.
The health insurance industry says it has data indicating Advantage members receive high-quality care with good outcomes. Critics say that's because healthier people tend to gravitate to Advantage's managed care plans, while those who need more care stick with traditional Medicare.
A spokesman for America's Health Insurance Plans didn't dispute the Avalere study, but questioned the star system.
"Some of the criteria are not objective, meaning that health plans may not be able to move up in the ratings," said Robert Zirkelbach.
Other industry representatives say there's room for improvement.
Humana is the state's largest Medicare Advantage provider, with 375,000 members. Most of its Advantage plans are rated 2.5 or three stars, while a few other plans were too new to be rated. A two-star rating is considered "fair" while three stars is considered "good."
Scott Latimer, who oversees the company's Advantage plans in Central and North Florida, said he thinks tying payments to performance makes sense. He said the company has made changes based on those ratings.
He cited its Humana Cares program as an example. The program was created two or three years ago as a way to help the company better manage the care of members with chronic conditions. Now, there are about 300 St. Petersburg-based nurses providing case management support via telephone to 55,000 of the company's Medicare Advantage members nationwide.
Does he think the company's Advantage plans can elevate to four- or five-star levels?
"It's doable. It's not impossible," he said. "We would like to perform at a five-star level."
Information from the Associated Press was used in this report. Richard Martin can be reached at firstname.lastname@example.org or (727) 893-8330.