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Medicare Advantage Program Standards Tightening

Christopher Cheney, for HealthLeaders Media, April 7, 2014

Removing the suite of set standards for four-star quality will pose a daunting challenge for MA insurers and their provider networks, Kavouras says, calling the proposed change "switching to grading on a curve… We won't know the rules we're being graded on until after the fact. It really confuses providers about the standards they are being graded on."

Having set standards for some four-star quality measures has allowed insurers and providers to work in tandem to achieve clearly understood and measurable quality goals. "It allowed us to work with our providers," Kavouras says. "Providers need and want to know what the benchmarks are."

In the proposed rules CMS acknowledges insurers' concerns, but contends the star ratings system needs restructuring:

"Whole stars contain less information than the corresponding measure data because there is information loss associated with converting a numeric scale to a 1- to 5-star rating. While we understand sponsors' perceptions that pre-determined four-star thresholds provide stability in setting performance expectations, in reality the use of pre-determined thresholds violates our principle of assigning stars that maximize the difference between star categories."


Christopher Cheney is health plans editor at HealthLeaders Media.
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