Underreporting High-Risk Prescribing Among Medicare Advantage Plans: A Cross-sectional Analysis

Annals: 10/110/1/13


Background: Although Medicare Advantage plans are required to report clinical performance using Healthcare Effectiveness Data and Information Set (HEDIS) quality indicators, the accuracy of plan-reported performance rates is unknown.

Objective: To compare calculated and reported rates of high-risk prescribing among Medicare Advantage plans.

Design: Cross-sectional comparison.

Setting: 172 Medicare Advantage plans.

Patients: A random sample of beneficiaries in 172 Medicare Advantage plans in 2006 (n = 177 227) and 2007 (n = 173 655).

Measurements: Plan-reported HEDIS rates of high-risk prescribing among elderly persons were compared with rates calculated from Medicare Advantage plans’ Part D claims by using the same measure specifications and source population. Read more