Better Medicare Alliance Responds to OIG Report on Chart Reviews and Health Risk Assessments

Washington, D.C. – Better Medicare Alliance, the nation’s leading research and advocacy organization supporting Medicare Advantage, responded today to a U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) report on the use of chart reviews and health risk assessments (HRAs) in Medicare Advantage.

“Seniors receive better care in Medicare Advantage because of the program’s early identification and treatment of disease and chronic conditions. Chart reviews and HRAs conducted in Medicare Advantage provide invaluable insights about beneficiaries’ physical, mental health, and social risk factors. These clinical tools play a critical role in identifying conditions and unmet health needs earlier and driving better outcomes for the 27 million diverse beneficiaries in Medicare Advantage. This includes a 43% lower rate of avoidable hospitalizations, a 5% lower rate of all-cause readmissions, and higher rates of breast and prostate cancer screenings, as compared to FFS Medicare,” said Mary Beth Donahue, President and CEO of the Better Medicare Alliance. “The realities of the COVID-19 pandemic and the corresponding rise of social isolation, food insecurity, and other challenges for seniors underscore the importance of better understanding the health and well-being of the beneficiaries that physicians and health plans serve in Medicare Advantage. Chart reviews and HRAs equip health plans to focus on prevention, primary care, chronic care management, and social determinants of health for the proportionately lower-income, more socially at-risk, and more medically complex beneficiary population served by Medicare Advantage. They also help to ensure adequate, appropriate funding for the increased health care needs of beneficiaries with these complex, chronic conditions.”

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