Insurers Gaming the System via Contract Consolidation

A few weeks ago, the Wall Street Journal released an article outlining how insurers are gaming Medicare Star Ratings through a process known as “crosswalking”. The article points out that insurers, such as Humana and United, systematically consolidated members from under-performing contracts to higher performing ones to preserve bonuses reserved for high performing contracts. Here at Baltimore Health Analytics, we created a contract history browser to help outline and map this trend.

The WSJ cited Humana contract H6609 as the perfect example: a highly rated plan and home to more than 700,000 members in 2017. Following a drop from 4.5 stars in 2015 to 3.5 stars in 2017, the plan, along with four others, was dissolved into a 4 star, 50,000 member plan (H5216). As of the latest data released in February, H5216 currently has 1.14 million enrollees. Humana is eligible to collect bonuses on every member due to this maneuver, despite the fact over a million of them were not eligible at the end of last year.

This same practice can also be seen in United contract H2228 as shown below:

It will be interesting to see what United chooses to do with this contract now that it has dropped from 4.5 to 3.5 stars, eliminating their high quality bonus eligibility.

Despite these current movements, the future of crosswalking looks limited due to the two-year budget deal recently signed into law (its effects will not be seen until 2020). Following its implementation, consolidated contracts will be weighted properly, making it nearly impossible to disguise underperforming giant contracts in a well performing small contract.

To see a more expanded view of the effects ofcrosswalking, we created a tool that shows the entire history as a tree with all plans, their stars, antecedents, populations, etc. And the best part it’s free, just like our other tools: Stars Planner, Stars Mapper, and Measure Details. To do your own crosswalk research, type “United”, Humana”, “Cigna”, etc. to see all their plans from past years along with their data. The source for this is a scrubbed version of the annual crosswalk table from CMS.