Medi­care Ad­van­tage star rat­ings to be re­leased

Modern Healthcare - - THE WEEK AHEAD - —Bob Her­man

The CMS will re­lease 2016 star rat­ings for each Medi­care Ad­van­tage plan on Thurs­day, and ex­perts pre­dict more in­sur­ers will re­ceive higher qual­ity scores as they adapt to the gov­ern­ment’s more rig­or­ous stan­dards.

“The in­dus­try com­plains, but de­spite all the rhetoric, they’re ac­tu­ally re­spond­ing,” said Richard Lieber­man, chief data sci­en­tist at Mile High Healthcare An­a­lyt­ics.

Com­pa­nies are as­signed a star rat­ing on a scale of one to five. Many mea­sures go into the cal­cu­la­tion, in­clud­ing those in­volv­ing the care process.

For ex­am­ple, in 2015, if at least 60% to 76% of fe­male mem­bers in an Ad­van­tage plan who broke a bone re­ceived screen­ing or treat­ment for os­teo­poro­sis within six months, then the plan would re­ceive four stars for that par­tic­u­lar rat­ing. Nu­mer­ous other mea­sures ex­ist.

Plans are get­ting savvy at man­ag­ing those process mea­sures, Lieber­man said. By con­trast, low-per­form­ing plans are strug­gling with mem­ber ex­pe­ri­ence mea­sures—those that gauge whether en­rollees are happy with their doc­tors and phar­ma­cies, and whether providers are de­liv­er­ing care with good out­comes.

“That’s where plans are go­ing to com­pete for mar­ket share down the line,” Lieber­man said.

At­tain­ing four or five stars doesn’t just at­test to a plan’s higher qual­ity; it also leads to more money. Health plans with at least four stars re­ceive a 5% bonus pay­ment, while those with three or fewer get noth­ing ex­tra.

In 2015, 72 in­sur­ers had Ad­van­tage plans with at least four stars. Only seven com­pa­nies had five-star Medi­care plans.

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