Half of Medicare Advantage Drug Plans Earn 4 Stars or Higher

When weighted for enrollment, more than 68% of enrollees in plans with prescription drug benefits are in contracts with four or more stars, a three percentage point drop from 2016.

Nearly half of the nation's 364 Medicare Advantage plans with prescription drug benefits (MA-PD) earned four stars or higher in the Centers for Medicare & Medicaid Services five-star scoring scheme for 2017, CMS reported Thursday.

When weighted for enrollment, more than 68% of MA-PD enrollees are in contracts with four or more stars, a three percentage point drop from 2016. In addition, the number of active and rated contracts, and the percent of MA-PD enrollees weighted by enrollment in contracts with four or more stars in 2017, is approximately the same as in 2016.

When weighted by enrollment, more than 90% of MA-PD enrollees are in contracts with ratings of 3.5 or more stars, CMS said.

Sean Cavanaugh, deputy administrator and director of the Center for Medicare, said in a blog post this week that Medicare's prescription drug programs have improved significantly in the past decade. In 2009, for example, only 27% of enrollees were in plans with four stars or more.

"Plans that are rated higher deliver a higher level of care, such as improving the coordination of care, helping enrollees to manage diabetes or other chronic conditions more efficiently, screening for and preventing illnesses, or making sure people get much-needed prescription drugs," Cavanaugh said.

"A high rating also means that these plans give better customer service, with fewer complaints or long waits for care."

Stars Rise, Fade in 2016 Medicare Advantage Ratings

For the 55 Medicare Part D Prescription Drug Plans (PDPs) rated in 2017, 49% (27 contracts) received four or more stars. When weighted by enrollment, 41% of PDP enrollees are in contracts with four or more stars, which represents a nine percentage point increase from 2016, CMS said.

Two plans were slapped with a low-performing Icon:

• Phoenix Health Plans, Inc., a subsidiary of Tenet Healthcare Corporation, with 13,777 enrollees
• GHS Managed Health Care Plans, Inc., a subsidiary of Health Care Service Corporation, with 4,550 enrollees.

Both plans received summary ratings of 2.5 stars or less from 2015 through 2017, which means that their contracts with Medicare could be terminated in 2017 if they don't improve.

As in past years, non-profit plans continued to outperform for-profit plans in the 2017 Star Rankings for MA-PDs. Approximately 70% of non-profit plans received four or more stars, compared with only 39% of for-profit MA-PDs. And, just as in 2016, 63% of non-profit PDPs received four or more stars, compared with only 24% of for-profit PDPs.

The 12 new 5-star contracts for this year are:

• KS Plan Administrators, LLC
• BCBS of Massachusetts HMO Blue, Inc.
• Aultcare Health Insurance Corporation
• Physicians Health Choice of Texas, LLC
• CDPHP Universal Benefits, Inc.
• Optimum Healthcare, Inc.
• Kaiser Foundation HP, Inc. (MA-only)
• Anthem Insurance Co. & BCBSMA & BCBSRI & BCBSVT (PDP)
• Excellus Health Plan, Inc. (PDP)
• BCBS of Michigan Mutual Insurance Company (PDP)
• Wellmark IA & SD, & BCBS MN, MT, NE, ND, & WY (PDP)
• Dean Health Insurance, Inc. (PDP)

As in prior years, the length of time that a particular plan had with Medicare Advantage was another key indicator of success. More than 56% of the MA-PD plans that earned four or more stars have been involved with the program for more than 10 years. None of the 59 MA-PD contracts with five years or fewer experience in Medicare Advantage earned five stars, while more than 47% of earned three or fewer stars. View full details.

Methodology

For the 2017 Star Ratings, CMS said outcomes and intermediate outcomes continue to be weighted three times as much as process measures, and patient experience and access measures are weighted 1.5 times as much as process measures.

The Star Ratings measure:

• Outcomes
• Intermediate outcomes
• Patient experience
• Access
• Process

For the 2017 Star Ratings, outcomes and intermediate outcomes are weighted three times as much as process measures, and patient experience and access measures are weighted 1.5 times as much as process measures. CMS assigns a weight of 1 to all new measures. The Part C and D quality improvement measures receive a weight of 5 to further reward contracts for care improvements provided to Medicare enrollees.