List date(s) this work was published or aired.
10/18/2012
Provide a brief synopsis of the story or stories, including any significant findings.
Even the savviest shoppers will pay more for top quality and that’s the theory behind the bonuses the federal government pays health insurers if they do a good job caring for 13 million beneficiaries in Medicare Advantage (MA) plans. The bonus system came under attack in 2011 after Medicare officials announced a special pilot project that would make it easier for insurers to earn the bonuses. Although the skepticism persists, little attention has focused on how much extra — if any — the bonuses provide. Insurers are supposed to use the extra payments to improve benefits for their members or lower their premiums. After analyzing payment data for plans in more than 3,200 counties in every state and U. S. territory, reporter Susan Jaffe found that the 2013 top bonus payments of five percent intended to reward MA plans earning five stars, may not offer much of an incentive to improve.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Jaffe avoided the time-consuming FOIA process by finding and downloading two years of payment data from an obscure CMS website. The data included bonus payments for plans in more than 3,200 counties in every state and U. S. territory. The idea for the story emerged after she analyzed the payment changes from 2012 to 2013, looking for the counties with largest pay cuts and increases in dollars as well as the rate of change. In some counties, the top-rated plans saw a 10 to 17% raise compared to cuts of up to 39 percent in other counties. Jaffe asked CMS to confirm her methodology by providing data for a sample county, which it did.
Explain types of human sources used.
Stephen Hemsley, CEO of UnitedHealthcare; David Langness, spokesman for Kaiser Permanente, Nancy Cocozza, senior vice president at Coventry Health Care; Vanessa Olson, actuarial director for Humana; and Jennifer Rak, senior manager in Health Policy practice at Avalere Health.
Results:
Because of overall cuts in payments for 2013 and a payment formula that varies from county to county, 2013 bonus payments for the best-rated plans (earning five stars) in nearly 1,000 counties is close to what the lowest-rated plans in those counties received in 2012 – with the exception of 48 counties where the 2013 top five-star plans will earn less than 2012’s worst-performing plans in the same county. Readers also learned for the first time that payments for MA plans offered in one-third of U.S. counties — including those in the territories (Guam, Puerto Rico and the Virgin Islands) and the District of Columbia — will be smaller next year. Supplemental state charts in an easy-to-understand format illustrated the local impact by providing MA plan payments by county for 2012 and 2013.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No
Advice to other journalists planning a similar story or project.
Read between the lines of press releases by checking the data that is supposed to back up the view conveyed to the public. Follow your hunches. If there’s too much data, limit your initial analysis to a key state or provider. Ask CMS or an expert to confirm a sample of your analysis before spending a lot of time on a project. The charts also tell the story. Ask your editors to edit and refine how the data is presented so that readers are not overwhelmed with numbers.