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Having helped several Medicare Advantage plans achieve significant quality performance improvements (up to 1.1 stars improvement YoY in 2020 alone), Stellar Health (Stellar) is sharing its perspective on what it takes to sustain and improve Star Ratings for health plans and why there is a need for action despite even a few years of success.
There is an ever-growing number of Americans (24 million) currently enrolled in a Medicare Advantage (MA) plan, doubling over the past decade, and expected to rise significantly by 2030. In light of this growth, MA payors are fighting to accommodate such volume, while remaining competitive. To capture the high demand for MA, payors are finding it imperative to make their plans more appealing by improving their Star Ratings – a Centers for Medicare and Medicaid Services (CMS) scoring system (1 – 5 stars) based on each plan’s performance across several measures that focus on customer satisfaction and quality of care the plan delivers.
CMS has designed the Star rating system to reward those health plans that drive greater quality of care and help Medicare beneficiaries select a higher quality product. Health plans that achieve a 4 Star rating or above receive up to a 5% increase to their monthly per-member payments. In addition, plans achieving a 5-star rating can also enroll members throughout the year, as opposed to only during the late fall Annual Election Period (October 15 to December 7 each year). In 2020, about 13 million Medicare beneficiaries had access to a CMS 5-Star quality rated plan and could use the 5-star Special Enrollment Period2. Additionally, over 57% of all MA members are enrolled in a plan with 4-stars or more. These added benefits along with the ever-increasing competition from new entrants and established names have made it extremely important for payors to achieve, maintain, and most importantly, improve performance on a yearly basis, even perhaps despite their historical success.