Incenting Medicare STARS Clinical Health Measures: Evaluation of Part C HEDIS Measures

Background: Medicare Advantage (MA) health Plans provide health insurance to a large portion of Medicare recipients. Since passage of the Affordable Care Act, MA Plans have received substantial bonus payments based on their STAR rating, a measure of the quality of health care delivered by the Plan. Part C of the Healthcare Effectiveness Data and Information Set (HEDIS) provides the clinical measures used to assign a STAR rating to the clinical performance of a MA health care Plan. Objective: To evaluate the clinical measures listed in Part C of the HEDIS set to determine which measures would be best incentivized by a MA Plan in physician contracts. Methods: The measures listed in Part C of the HEDIS data set were assessed to identify those with the potential to change physicians' practice towards a higher STAR rating. Eight measures were selected: breast cancer screening, colorectal cancer screening, osteoporosis management, diabetic eye exam, diabetic kidney disease monitoring, diabetic glucose control, blood pressure management, and rheumatoid arthritis (RA) management. Individual measures were evaluated from the framework of the relevant stakeholder perspectives involved in performance of the measure: the patient, the insurance provider, the physician, and society. Result tables were used to report each measure's performance and feasibility for physician-contract incentives by each of the four relevant perspectives. Each clinical measure was assigned a score based on its performance within the four selected perspectives. Results: Of the eight relevant clinical measures of the Part C HEDIS data set, blood glucose control and RA management offered the greatest benefit to the patient based on the magnitude of improved health and avoidance of disease complications. Diabetic kidney disease management was found to be the most favorable candidate from the insurer's perspective owing to the low cost of testing and treating, while avoiding expensive complications. The physicians' perspective received most benefit from diabetic eye and kidney disease measures due to the absence of significant barriers in completing the measure and the ease of reporting measure completion. Societal benefits were greatest in colorectal cancer screening based on their ability to both reduce a significant societal disease burden and the potential to improve health care disparities. Conclusion: This evaluation of the clinical measures of Part C HEDIS data plan found that diabetic kidney disease monitoring benefitted all stated perspectives and is a good measure to incentivize in physician - MA carrier contracts.Master of Public Healt