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Alliance Calls for Data Transparency in Medicare Advantage Program

Published May 29, 2024

Stethoscope laying on a page about alzheimer’s disease.

The Alliance today responded to a request for information (RFI) from the Centers for Medicare and Medicaid Services (CMS) on data collection in the Medicare Advantage program. Our comments focused on the power of robust data collection to aid in the creation of policy that improves the experience of beneficiaries and ensures optimal patient care. The letter continues the Alliance’s work of bringing attention to the potential for abuse of utilization management techniques in Medicare Advantage plans due to changes to the Medicare Part D program that were passed in the Inflation Reduction Act of 2022, and CMS’ promise only to “monitor” those changes.

The Alliance recommended increased data monitoring in the following areas:

  1. Formulary changes of drugs and therapeutics;
  2. Data on algorithms, artificial intelligence, and automatic denials of care;
  3. Appeals data; and
  4. Data on utilization changes for underserved communities and underrepresented populations.

Additionally, the letter emphasized the need for CMS to address data transparency and encouraged CMS to allow beneficiaries to be made aware at the time of enrollment of changes to formularies, utilization management, and other potential costs.

Read the full letter.

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