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Medicare Advantage Program Standards Tightening

Christopher Cheney, for HealthLeaders Media, April 7, 2014

"There's a huge financial and competitive advantage to companies that can sustain four stars," Kavouras said of the anticipated 2015 program, noting Aetna has been investing bonus payment dollars back into its MA health plans to help achieve quality standards and lower costs.

The six percent payment rate cut to MA health plans in 2014 and the anticipated six percent cut in 2015 heightens the importance of the bonus payments for insurers, he says.

"Medicare Advantage payment cuts are hitting a level now where health plans are going to have to make choices," Kavouras says. "Plans will have to make choices if they are not getting those bonus payments."

In the proposed 2015 MA payment rate and rules document released in February, the star ratings program was described by CMS as an essential element to achieving quality. The agency noted that it is striving to optimize the program.

"One of CMS's most important strategic goals is to improve quality of care and general health status for Medicare beneficiaries," the document states. "For the 2015 Star Ratings…Our priorities include enhancing the measures and methodology to reflect the true performance of organizations and sponsors, maintaining stability due to the link to payment, and providing advance notice of future changes."

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