Medicare Advantage Quality: Star Rating

Quality care in Medicare Advantage is measured and reported through a Star Rating System. The system plays a critical role in promoting quality, ensuring public accountability, and giving beneficiaries the tools to choose high quality plans.

Key Facts:

• The Star Rating System sets quality measures for Medicare Advantage and Part D plans and helps beneficiaries pick a plan based on quality performance.

• The Star Ratings are based on plan performance on 44 measures ranging from managing chronic conditions to member experience.

• Plans with Star Ratings of at least 4 Stars receive bonus payments that are used to offer additional benefits to enrollees.

• 77% of beneficiaries in Medicare Advantage plans are projected to be in 4 or 5-Star plans.

• CMS should improve Stars quality measures and align them with other public programs.

• CMS should release Star Ratings and measurement targets prospectively.

Policy Recommendation:

CMS should continue to improve quality measures in the Star Rating System to better measure outcomes, and incentivize value based care. CMS should work to align quality measures across public programs to seamlessly integrate incentive structures, ease clinician burden, and increase overall system transparency.

CMS should also release Star Rating System measurements and targets prospectively.

Fact Sheet

Fact Sheet: Measuring Patient Experience of Medicare Advantage Beneficiaries: Current Limitations of the Consumer Assessment Tool and Solutions for Improvements January 27, 2021

This fact sheet summarizes a report from Better Medicare Alliance and NORC at the University of Chicago which examines the current limitations of measuring patient experiences in the Medicare Advantage and Prescription Drug (MA-PD) Consumer…

Quality

Payment

Report

Measuring Patient Experience of Medicare Advantage Beneficiaries: Current Limitations of the Consumer Assessment Tool and Policy Recommendations January 27, 2021

In this report, Better Medicare Alliance and researchers from NORC at the University of Chicago examine the current limitations of measuring patient experiences in the Medicare Advantage and Prescription Drug (MA-PD) Consumer Assessment of Healthcare…

Quality

Payment

Fact Sheet

Primary Care & Early Disease Intervention Fact Sheet January 27, 2021

Focus on primary care in Medicare Advantage improves preventive care and works to slow disease progression. Practitioners in Medicare Advantage are encouraged to provide timely screenings, early intervention, care coordination and engage with beneficiaries.

Chronic Care

Health Outcomes

Background Information

Patient Centered Care

Quality