Medicare Advantage, privately run health plans paid for by Medicare, have covered an increasing number of seniors and disabled people in recent years. More than 1/3 of the 58 million Medicare beneficiaries opt for these non-traditional plans.
The government has been collecting data about the care delivered to these enrollees since 2012. Last year, it began using the data to calculate payments to private insurers and officials at the Centers for Medicare and Medicaid Services were preparing to turn the data over to the public.
The Medicare Advantage data was slated to be made public at the annual meeting of AcademyHealth in New Orleans. But the session was canceled at the last minute, catching researchers and ex-Medicare officials by surprise.
CMS defended the move, saying that it would examine the 2015 numbers “to determine if it is robust enough to support research use.”
The announcement was “hugely disappointing” to former CMS chief data officer Niall Brennan, who tweeted, “Hope CMS is not backsliding on #opendata.”
Health economist Austin Frakt told ProPublica that he wanted to see the data as a researcher, but also as a taxpayer.
“We are paying an enormous amount of money to private insurance companies … but we know very little about what we’re getting for that money,” he said told the news outlet.
Data for traditional Medicare plans have been available for decades.
“The claim is that private insurers are innovating in ways that traditional program is not,” Frakt added. “We need to validate that. We need to know what they’re doing for the benefit of everyone. We can’t do that without the data.”
The private insurers in charge of Medicare Advantage plans have faced criticism lately for potentially overcharging Medicare. In 2014, the Center for Public Integrity reported that insurers collected $70 billion in inappropriate payments between 2008 and 2013.
According to statements made by a spokesperson for America’s Health Insurance Plans, the insurance industry did not request that CMS delay the release of the much-anticipated data, although it has been questioning the data’s accuracy.
“The system used to capture encounter data has numerous unresolved operational and technical issues and fails to capture a reliable, comprehensive picture of beneficiaries’ diagnoses,” the spokeswoman told ProPublica. “This could put payments at risk, which could also increase premiums and decrease benefits. We look forward to working with Administrator Verma and CMS to improve the encounter data and address these issues.”
