Federal data shows a lift in quality rankings for Medicare Advantage health plans with and without prescription drug coverage—and a steep drop in the number of lowest-performing plans.
Ratings data released for Medicare Advantage plans shows significant year-over-year improvement in the number of plans earning top rankings, which "are driving improvements in Medicare quality," says the Centers for Medicare & Medicaid Services.
"We continue to see increases in the number of Medicare beneficiaries in high-performing [five-star] Medicare Advantage plans," the Centers for Medicare & Medicaid Services says a fact sheet released with the star ratings for 2015. "This year, there are significant increases in the number of Medicare beneficiaries in high-performing Prescription Drug Plans (PDPs)."
Medicare Advantage Program Standards Tightening
CMS also noted a striking decline in low-performing MA plans, citing an 80% reduction in the number of health plan contracts that received a "low-performing icon" designation for the 2015 star ratings compared to 2014.
CMS uses a five-star quality ranking system to rank
- Outcomes
- Intermediate Outcomes
- Patient Experience
- Access
- Process
Outcomes and intermediate outcomes are weighted highest with a relative value three times as much as process measures. Patient experience and access measures are weighted 1.5 times as much as process measures.
The ranking system is used by Medicare beneficiaries to compare health plans and by insurers, to determine "quality bonus payments" for plans that earn at least four stars. In 2015, three-star ratings will no longer be eligible for bonus payments.
14 Medicare Advantage Plans Earn 5 Stars (2014)
Compared to the current year's quality rankings, the 2015 data shows an 8% increase in the number of MA-PD health plan contracts with rating of four stars or higher.
5-Star MA Plans with Prescription Drug Coverage
- Kaiser Foundation HP, Inc.
- Kaiser Foundation HP, of CO
- CarePlus Health Plans Inc.
- Kaiser Foundation HP, Inc.
- Kaiser FNDN HP of the Mid-Atlantic States
- Group Health Cooperative
- Gundersen Health Plan
- Martin's Point Generations, LLC
- Healthspan Integrated Care
- Kaiser Foundation HP of the NW
- Providence Health Plan
5-Star MA-Only Plans
- Medical Associates Health Plan
- Dean Health Plan
5-Star Prescription Drug Plans
- HealthPartners, Inc.
- Wellmark IA &SD, & BCBS MN, MT, NE, ND, & WY
- Wisconsin Physicians Service Insurance Corp.
3 Factors Raise Rankings
Detroit-based Blue Cross Blue Shield of Michigan garnered a four-star ranking for its BCBSM Medicare Advantage PPO and a 4.5-star ranking for its BCN Advantage HMO. BCBSM is a nonprofit organization and the largest health insurer in Michigan, with about 4.4 million covered lives in the state.
Mary Smith, VP of BCBSM's Health Care Value Center of Excellence, said three factors have driven a track record of star-ratings success at the BCBS affiliate: "partnerships with physicians to improve quality, sustained operations measure performance, and improving the member experience."
Organizations that are non-profit tend to receive higher ratings than those that are for-profit, according to CMS. But in the final rule on health insurance exchanges, CMS declined to require that tax-status be disclosed.
In April, CMS confirmed that it intends to apply its five-star rating system to Medicare-eligible acute care facilities "maybe" as early as December.
Christopher Cheney is the CMO editor at HealthLeaders.