Olga Walther

GAO Recommends Use of Disenrollment Data to Strengthen Oversight in MA Program

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In a newly released report, the Government Accountability Office (GAO) recommended the Centers for Medicare & Medicaid Services (CMS) examine data on disenrollment by health status and the reasons beneficiaries disenroll to strengthen oversight of the Medicare Advantage program. The Department of Health & Human Services concurred with GAO’s recommendation.

GAO examined 126 contracts with higher disenrollment rates—above the median rate of 10.6% in 2014—and found 35 contracts with health-biased disenrollment. In these contracts, beneficiaries in poor health were substantially more likely (on average, 47% more likely) to disenroll relative to beneficiaries in better health. GAO concluded such disparities in contract disenrollment by health status may indicate the needs of beneficiaries, particularly those in poor health, may not be adequately met.

GAO found beneficiaries who left the 35 contracts with health-biased disenrollment tended to report leaving for reasons related to preferred providers and access to care. In contrast, beneficiaries who left the 91 contracts without health-biased disenrollment tended to report they left their contracts for reasons related to the cost of care.

While the report has some interesting data analysis, Julie Billman, Gorman Health Group’s Vice President of Operational Performance, points out the study does not account for the variable of the average health status for all members in the contracts included. Of the plans found to have health status disenrollments, the report indicates 37% of the contracts were likely to be mainly Special Needs Plans (SNPs) compared to only 21% in the non-health status disenrollments.

“As SNPs by their nature have sicker members with more chronic conditions, it would not be abnormal to see these plans having more members with poor health disenrolling as, on average, they have more members in poor health. Additionally, members in SNPs have the ability to change plans more frequently through the year, which could also skew the results. Comparisons among ‘like’ plans may give a clearer picture on whether this could be a valuable tool for CMS to utilize in the future. Member retention in health plans is important as it takes time to see the benefits of care coordination; both the member and the plan lose when continuity is lost,” explains Julie.



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Olga Walther

About Olga Walther

Olga Walther is Senior Legislative & Policy Advisor at Gorman Health Group (GHG). In this role, Olga is responsible for managing Medicare, Medicaid and healthcare reform policy issues in support of the day-to-day policy and legislative analysis and product development. Read more

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