Maine health group receives five-star Medicare Advantage rating

Posted Oct. 12, 2011, at 5:49 p.m.

PORTLAND, Maine — A Portland-based health care organization is one of just nine companies nationwide to receive the highest possible ranking for its Medicare Advantage programs, according to data released on Wednesday by the federal Centers for Medicare and Medicaid Services.

The rating identifies Martin’s Point Health Care as the only Medicare Advantage carrier in Maine, and one of just two in New England, to win the top-ranking five-star designation. The designation grants Martin’s Point significant benefits, including higher reimbursement levels than other Medicare Advantage plans as well as the ability to enroll new members year-round rather than only during the annual open enrollment period to which other plans are limited. That period runs from Oct. 15 to Dec. 7 this year and also is the window for enrolling in or changing Medicare Part D prescription coverage plans.

Martin’s Point covers Mainers throughout the state — a total of about 12,500 individuals — in one of three Medicare Advantage plans which are available to seniors over 65. That’s about one-third of all Medicare Advantage enrollees in Maine. The organization also provides other forms of health insurance and workplace wellness support for employers and owns primary health care practices in Portland, Brunswick, Bangor and Portsmouth, N.H.

Larry Henry, vice president for Medicare at Martin’s Point, said on Tuesday that the Centers for Medicare and Medicaid Services used patient records as well as patient satisfaction surveys to measure Medicare Advantage plans for their effectiveness in improving the health of enrollees. Plans that show high compliance with recommended, evidence-based practices that measurably improve members’ health scored higher than those that do not, he said.

“But the one we’re probably most proud of is our customer satisfaction,” he said. Enrollees in Martin’s Point Medicare Advantage plans consistently indicate a high degree of satisfaction, Henry said, in part because the organization is headquartered in Maine, where all its enrollees live.

“I think that really matters,” Henry said. “For one thing, it’s nice for a member to hear that we’re right down the road. But for our member services representatives, this is their home. They’re going to take care of their neighbors, and that really comes through.”

Medicare Advantage plans differ from traditional Medicare in that they are administered through a private insurance company. In addition, Medicare Advantage is modeled like a managed care plan, with each patient required to have a primary care provider who coordinates the patient’s care, including preventive and screening services, acute care for illness or injury, laboratory testing and diagnostic imaging, chronic disease management and referral to specialists.

Medicare Advantage plans have come under scrutiny in recent years because the tax-funded Medicare program pays more through the insurance company “middle man” than it pays directly to medical care providers. Under the reforms of the Affordable Care Act, payments to all but the highest-ranked Medicare Advantage plans are set to phase downward to come in line with traditional Medicare reimbursements. Until now, there has been no evaluation of which Medicare Advantage plans are the top performers and likely to result in better health for American seniors and overall savings in health care spending.

Wednesday’s release provides the first such review and rating of Medicare Advantage plans across the nation.

Spokeswoman Roseanne Palwelec at the Centers for Medicare and Medicaid Services regional office in Boston said the rating aims to raise public confidence in choosing a Medicare Advantage plan during the upcoming open enrollment period. Plans with a five-star rating and those that perform especially poorly will be identified, making it faster and easier for Medicare beneficiaries and their families to select an appropriate plan, she said.

In addition to Martin’s Point, other five-star organizations across the nation include: Kaiser Permanente doing business in Washington, Oregon, California, Colorado and Hawaii; Group Health Cooperative doing business in Washington; Medical Associates Health Plan doing business in Illinois and Iowa; Gundersen Lutheran Health System doing business in Wisconsin and Iowa; Advocare doing business in Wisconsin; Dean Health Plan doing business in Wisconsin; and Health New England doing business in Massachusetts.

Other organizations selling Medicare Advantage plans in Maine but not meeting the five-star standard are Northeast Community Care, Today’s Options, Aetna and United Healthcare.

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