Dr. Mehmet Oz, recently confirmed to lead the Centers for Medicare & Medicaid Services, has made … More
Dr. Mehmet Oz, the new administrator of the Centers for Medicare & Medicaid Services, has said he wants to give “power to the people.” Well, OK, he didn’t use those exact words, but healthcare consumer power was the core idea behind his stated goals of “empowering the American people” to “better manage their health” and holding providers “accountable for health outcomes.”
Although achieving those objectives won’t be easy, I’d like to suggest three quick actions that together would constitute a giant step forward.
Ensure Insurer Transparency
1. Order Medicare Advantage plans to disclose truly local quality ratings
The CMS star rating system for Medicare Advantage plans is controversial due to its high stakes and ever-evolving methodology. A five-star rating not only attracts members, it also boosts government bonus payments. At least five large insurers have sued the government over its latest changes.
Although MA now covers 54% of all Medicare beneficiaries, or nearly 34 million people, there’s a major flaw in its rating system that quietly blocks individuals from informed management of their health. Though you’d expect the rating of your local MA plan to reflect local experience, CMS actually rates plans by contract number.
Health care isn’t chain-restaurant hamburgers, delivered in comforting conformity everywhere. The quality of care can vary dramatically from place to place, yet the CMS approach allows one large insurer, for example, to aggregate quality information from 17 states as diverse as Rhode Island, Mississippi, Illinois, Colorado and California. That pooling has been known to open the door to statistical tricks designed to boost the star rating score.
Health insurers know local results. To empower individuals to better manage their health, CMS should order insurers to share them.
2. Tell the 11 million elderly in “accountable care organizations” about the board member representatives who are supposed to advocate for them
While MA gets the lion’s share of attention, another 11 million Medicare beneficiaries are part of so-called “accountable care organizations,” whose core mission is maintaining the health of those for whom they’re responsible; i.e., “make America healthy again” before Secretary of Health and Human Services Robert F. Kennedy Jr. coined the slogan.
But as with MA, the disempowerment is in the details. Regulations require ACOs to place a Medicare beneficiary, and sometimes also a consumer representative, on the board. However, the organizations are not required to proactively disclose those individuals’ names when enrolling ACO members or even to mention they exist. And if you can find the names, there’s no contact information.
Sustained sleuthing about my own ACO revealed that though it is owned by a nonprofit health system — by law, ACOs must be owned by providers — it’s actually managed by an out-of-state company that’s partially owned by a private equity firm. The Medicare beneficiary on the board listed as “retired” sold a company to a different private equity firm for $2.2 billion. The consumer rep is the ex-mayor of the town where the managing company is based. Other ACOs have chosen beneficiary representatives who are elderly hospital volunteers or retired doctors.
To make ACOs accountable to the public, not just to government, give consumers meaningful representation on the ACO board and ensure that representation is transparent.
Fix Medicare Compare
3. Make Medicare’s Compare website a place where information is easily findable and relevant to consumer decisions
The first time there was a nationwide survey of care quality at U.S. hospitals, the surgeons’ professional society conducting it found the results so upsetting they threw them into a hotel furnace at midnight and burned them so no one would find out. In the 100 years since, it’s become only moderately easier to unearth accurate and timely provider quality information.
For example, Medicare’s Compare website supplies information on doctors, hospitals, nursing homes, home health and other providers, but it’s both fragmented and 18 to 24 months old. Earlier this year President Trump issued an executive order ramping up price transparency by hospitals and insurers, whose foot-dragging has been rampant.
Consumers need quality information that’s as up-to-date as the information on cost. As measurement pioneer Walter Shewhart pithily put it, “Price has no meaning without a measure of the quality being purchased.”
Moreover, the site’s detailed comparison information can’t be directly accessed via a Google search or by ChatGPT. However, artificial intelligence chatbots will smoothly synthesize a compelling narrative on care quality that’s derived from online press releases and provider websites, though perhaps directing you to the Medicare site if you want something more.
CMS should make it a priority to fix Compare so that its information is relevant, timely and easy to find.
Power To The People
Pro-consumer rhetoric comes easily to policymakers, but giving power to the public requires taking it away from powerful industry players. That won’t be easy.
There are always alluring arguments for the status quo and against the strengthening of health care consumer power inherent in the three quick actions I’ve outlined. But to rebuild trust in U.S. health care and root out unnecessary costs and mediocre outcomes, Oz, with the full backing of the administration, should politely listen to those arguments — and then ignore them.
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