Revamping Patient-Reported Outcomes for Medicare Advantage Plans

Using patient-reported outcomes (PRO) data could be a better measure for risk adjustment payments for Medicare Advantage plans, but better strategies for collecting PRO data must first be developed, according to a recent report from the Government Accountability Office (GAO).

Patient-reported outcomes measures (PROMs) are indicators of functional status that the patient gives to their medical providers. Common PROMs include ability to carry groceries into a patient’s home, ability to button one’s shirt, or the ability to walk one city block. These measures look beyond a patient’s clinical status and instead at how a patient is able to live her life with certain medical issues.

PROMs, which look at functional status, may be better measures to inform risk adjustment payments for Medicare Advantage plans. CMS pays Medicare Advantage plans a risk adjustment payment to account for patients who are sicker and utilize the healthcare system more often than patients who are relatively healthier……more

Using Patient-Reported Outcomes Measures to Improve Engagement