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.