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.
• 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 47 measures ranging from managing chronic conditons to member experience.
• Plans with Star Ratings of at least 4 Stars receive bonus payments that are used to offer additional benefits to enrollees.
• Almost 70% of beneficiaries in Medicare Advantage plans are enrolled 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.
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.