Forum Session

Quality Stars: Medicare Advantage Plans and the Star Rating System
May 8, 2015

Manager

Lisa Sprague, MBA

Summary

Nearly 30 percent of Medicare beneficiaries are enrolled in a Medicare Advantage (MA) plan. Since 2007, the Centers for Medicare and Medicaid Services have used the Star Rating system, which assesses MA plans on dimensions such as clinical quality and customer service, to help consumers choose a health plan. Plans are rated on defined quality measures on a scale of one to five stars for each measure; ratings are then combined into a summary Star Rating. The Star Ratings program was also meant to drive quality improvement, and statistics speak to seeming success in this area with the average rating per contract steadily rising over time. Since 2012, Star Ratings have also played a role in MA plan payment: high-scoring plans are rewarded with shared savings and quality bonuses, enabling them to offer additional benefits or lower cost-sharing to beneficiaries. Policy issues include how performance metrics are developed, chosen, and maintained; how differences among beneficiary populations (particularly with regard to the dually eligible and those receiving low-income subsidies) should be recognized by the Star Ratings system; and the extent to which health plans can control the variables on which they are being measured. This Forum session explored MA plans' experience with the Star Ratings system, considering whether it has served to drive quality improvement, how accurately it reflects plan management of quality and service, and what might improve its operation and utility.

Speakers

Adam Zavadil, MPH, JD (bio)
Director, Market Strategy and Analysis, Alliance of Community Health Plans
Slides

Amy Compton-Phillips, MD (bio)
Chief Quality Officer, Permanente Federation (Kaiser Permanente)
Slides

Stacia Cohen, RN, MBA (bio)
Vice President, Medicare Star Center of Excellence, Blue Cross Blue Shield of Minnesota
Slides

Joyce Chan, MBA (bio)
Vice President, Clinical Performance, Healthfirst (New York City)
Slides

Related Materials

See also our paper, "The Star Rating System and Medicare Advantage Plans" (Issue Brief No. 854, May 5, 2015).

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