Monday, July 14, 2014

The Medicare Advantage Stars Program: Who Keeps the Money, Is it Evidence-Based and What About Variation?

The Population Health Blog has been practically banished from our living room when the spouse is watching TLC's Say Yes to the Dress.  This reality show follows the travails of young brides as they search for that perfect wedding gown while also dealing family expectations, tight budgets and dubious body art. 

When the PHB stops in and pauses to watch the bridal drama unfold over more than just a few minutes, it naturally wants to share.  Mysteriously, the spouse treats its helpful outreach like some sort of provocation.
Little wonder.  Years ago, the PHB medical director learned that the best way to make itself unwelcome at dreary management meetings dealing with the Medicare Advantage STARS Program was to inconveniently offer various insights, such as:

"If we hit the STARS target, let's not keep the millions in bonus payments; they should be distributed to our enrollees or used to lower premiums in the form of P4P4P."
"Too bad there is no randomized trial that shows that any of this help patients live longer.  Should we tell them that this isn't evidence-based?"

"If there is a small improvement, it could be the result of case mix or statistical variation."

And its innocent Yes to the Dress insights?

"All those dresses look pretty much the same!"

"I hope the groom takes a look at that mom, because if that's what the bride is going to look like years from now, he may want to reconsider."

"Seems to me she's trying to fit 50 pounds of potatoes into a 30 pound bag!"

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