Do Stars Matter?

I have occasionally made the point that MA can have a positive impact on members’ lives in a way that fee for service Medicare can never replicate.  Over the weekend, I was catching up on old journals and ran across a nice case in point.  If you are like me, you have wondered from time to time whether there was a real point in some of the Stars and HEDIS data you collect (particularly some of the survey questions) or whether it was just filler to make a bureaucrat feel more useful.  Well, here is a reassuring answer to that question:

You are probably aware that one of the HEDIS/HOS indicators is “the percent of sampled  Medicare enrollees 65 years of age or older who had a doctor’s visit in the past 12 months and who received advice to start, increase, or maintain their level of exercise or physical activity.”  (It takes at least a 60% positive from the sample to get a plan to four stars.) Another requirement (HEDIS) is that you measure BMI at least yearly in members less than 74 years old.  Does all that really matter?

It will probably come as no surprise to you that 20% of adults over 65 are obese (BMI>30) and that the number is rising every year.  What you may not have thought about is that obesity is now one of the major causes of frailty in the elderly.  The archetypal “little old lady” slowly maneuvering across the room with her cane has been replaced by the very big old lady (or old man) maneuvering through a grocery store on a scooter.

A group led by the geriatricians at Washington University in Saint Louis looked at the problem: they did a one year controlled study of the effects of diet and exercise in the obese elderly.[1] One study group did what they had always done (or not done), a second group dieted, a third group exercised, and a fourth group dieted and exercised.  Each group that did something did better than the group that did nothing but the fourth group did best of all.  Their strength went up 35%; their gait speed increased 23%; the rate at which they lost bone decreased; their peak oxygen consumption (a reflection of the ability to be active) increased; their balance improved and their risk of falling decreased.

We are accustomed to thinking about weight loss and exercise programs in younger adults as ways to prevent hypertension, diabetes, and other chronic illnesses.  It is a different matter in the elderly.  For them it is a way to directly and significantly improve the quality of life.

So should MA plans take pride in the fact that they are collecting data about exercise and weight loss and that the good ones are finding better ways to use that data to help their members get thinner and more active? You bet they should.