Humana Gold Plus took a big leap in Medicare's quality ratings in just one year by paying bonuses to groups of doctors who produced results, the company said.
The company paid $34 million in bonuses to more than 900 Florida primary-care physician practices that did the right things at the right time, documented what they did and got better outcomes for patients, spokesman Mitch Lubitz said.
Health News Florida reported on Thursday that Humana Gold Plus, Florida's largest Medicare Advantage plan, was the only statewide plan to reach the level of 4.5 stars in a 5-star scale. No plan in the state achieved a 5-star rating.
The company calculated the bonus totals and provided them to HNF late Thursday; see the updated story.
Another option: listen to a conversation about the Medicare ratings between WUSF News Director Scott Finn and Health News Florida Editor Carol Gentry about the companies that rated high and low on the quality scale. That conversation includes comments from Humana Central Florida Senior Market President Dr. Scott Latimer.
The Medicare ratings, aimed at improving performance of the plans, were part of the Patient Protection and Affordable Care Act (ACA or "ObamaCare"). It authorizes the Centers for Medicare and Medicaid Services to withhold part of the plans' payments and then give it back to the ones that score well.
Currently, plans that score 3 stars or higher get some of the money back, but after 2014, only plans that score 4 or 5 stars will qualify. And the 5-star plans are allowed to enroll beneficiaries all year, not just during open-enrollment.
There's also a penalty for plans that are rated below average. CMS is currently mailing letters to members of those plans, encouraging them to switch to a higher-ranked plan during open enrollment season. It began Oct. 15 and ends Dec. 7.
One that rated below average, St. Petersburg-based Universal Health Care, declined a request for an interview but has offered more detail in how it plans to improve its ratings. Chief Administrative Officer and General Counsel Sandip Patel sent an e-mail that said the company takes the 5-star quality initiative seriously and is working hard to improve in all areas.
The company will be sending its own letter to members to explain what it is doing to enhance quality and why they received the CMS notice.
Patel said Universal has launched a program called “100 Days of Hassle-Free Health Care," in which members who are newly enrolled or changing plans will have dedicated staff members to answer questions, set up appointments, and so on. Members will also be educated on the importance of screenings.
He said the company is adding staff who are skilled in quality improvement methods and predicted Universal's scores will rise.
--Health News Florida, journalism for a healthy state, is a service of WUSF Public Media. Questions? Comments? Contact Carol Gentry at 813-974-8629 or 727-410-3266 , or by e-mail at Carol.Gentry@HealthNewsFlorida.org.
