Stars Rise, Fade in 2016 Medicare Advantage Ratings

When weighted for enrollment, more than 70% of MA-PD enrollees are in contracts with four or more stars, a nearly 11 percentage point in increase from 2015, CMS said. But six health plans that have received fewer than three stars for the past three years face termination by Medicare.

Nearly half of the nation's 369 Medicare Advantage plans with prescription drug benefits (MA-PD) have earned four stars or higher in the Centers for Medicare & Medicaid Services five-star scoring scheme, up nine percentage points from 2015, CMS's reported Thursday.

When weighted for enrollment, more than 70% of MA-PD enrollees are in contracts with four or more stars, a nearly 11 percentage point in increase from 2015, CMS said.

As has been the case in past years, non-profit plans continued to outperform for-profit plans in the 2016 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. Similarly, 63% of non-profit PDPs received four or more stars, compared with only 24% of for-profit PDPs. 

CMS said the length of time that a particular plan had with Medicare Advantage was another key indicator of success. For example, more than 60% of the 202 MA-PD plans that earned four or more stars have been involved with the program for more than 10 years. None of the 44 MA-PD plans with five years or less experience in Medicare Advantage earned five stars, while 43% of earned three or fewer stars.

The 12 highest-performing (five-star) MA-PD plans:

Low Performers
It was not all good news. Six health plans that have received fewer than three stars for the past three years face termination by Medicare. These so called "death row" plans include:

The annual release of the Star Ratings, in place for nearly a decade, prompts an avalanche of self-congratulatory press releases from plans that have earned four or more stars. There is more at stake than bragging rights, however, because CMS has also attached financial incentives to the ratings for plans earning four or more stars.

The Star Ratings measure scores of quality and performance measures in the various Medicare Advantage plans that take into consideration outcomes, intermediate outcomes, patient experience, access, and process.  

For the 2016 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.

CMS said it 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 the strides they made to improve the care provided to Medicare enrollees. CMS said it will continue to lower the overall Star Rating for contracts with serious compliance issues, defined as the imposition of enrollment or marketing sanctions.   

Additional information is on a fact sheet provided by CMS.