MedPAC suggests ways to close Medicare Advantage data gap

Data Medicare Advantage insurers provide to the federal government has become more complete in recent years, but gaps remain, according to MedPAC's annual report, titled "Medicare and the Health Care Delivery System." 

The Medicare Payment and Advisory Commission advises Congress on Medicare. It published its annual report on healthcare delivery June 13. 

The commission found that data completeness improved from 2017 to 2020 and 2021 for some measures but "generally remained incomplete," according to the commission's report. Since 2012, Medicare Advantage plans have been required to submit a record of each encounter enrollees have with a healthcare provider to the federal government. 

The share of contracts reporting at least one encounter in all six service categories improved from 80% in 2015 to 96% in 2020, the commission found. However, data plans reported to CMS are not internally consistent, according to the report. Discrepancies between HEDIS data submitted to CMS and data submitted in bid proposals by plans were often inconsistent. 

In 2019, MedPAC recommended Congress implement three items to improve the completeness of Medicare Advantage encounter data. The committee re-upped its recommendations in the 2024 report: 

  1. Establish thresholds for complete and accurate MA data. 
  2. Evaluate data MA plans submit and require CMS to provide feedback to organizations. 
  3. Withhold a portion of plan payments from organizations that do not meet required thresholds. 

CMS is eyeing improving data collection and transparency from Medicare Advantage plans. In January, the agency issued a request for information seeking feedback on data collection in all aspects of the program, including prior authorization, provider networks and directories, supplemental benefit use, quality and outcomes, and the effect of vertical integration. 

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