Star ratings jump strengthens enrollment, performance of Medicare Advantage plans

The Medicare Advantage program continues to grow in popularity with both consumers and health plans. 

At least one-third of seniors are estimated to be in an MA plan rather than fee-for-service Medicare. As baby boomers retire in large numbers, health plans are competing to capture the Medicare Advantage market. 

One edge is to have great results from consumer satisfaction surveys used for star ratings.

A recent Navigant study shows that just a 1-star rating improvement increases enrollment by 8-12 percent. If the jump is from a 3- to a 4-star rating, the results are a 13 and 17 percent enrollment increase.

"From an analysis perspective, Medicare Advantage is expanding," said Jim Smith, managing director of Navigant and a co-author of the study. "It has led to an increase in the number of issuers in the marketplace. The ratings and enrollment have become extremely important."

For this reason, and because they can net a quality bonus payment of 5 percent, star ratings are high on every health plan's leadership, said co-author Eric Meinkow, a director with Navigant.

"It's very attractive," Meinkow said. "If you're going to be sustainable over the long term, you're going to need that 5 percent."

To improve star ratings, what's needed is integration, they said.

Health plans need to collaborate with clinically integrated networks of providers, because a lot of the star ratings improvements correlate around the providers themselves.

Providers have incentive through financial benefits, or losses, such as readmission penalties.

"The success of star ratings is not just a health plan charge," Smith said. "We're seeing more around collaboration between providers and payers."

One is the recent partnership between Aetna and Allina Health to form a health plan that will eventually offer Medicare products.

Last year Anthem Blue Cross Blue Shield of Ohio said it was working with the Cleveland Clinic to offer a new Medicare Advantage plan, and the Cleveland Clinic also partnered with Humana on two MA plans.

"The beauty of these networks," Smith said, "is they establish value. They have the goal of raising patient experience. Integrated networks are trying to provide a high level of service."

As the Centers for Medicare and Medicaid Services keeps raising the star ratings bar, there's no rest from the goal of continually improving. If a plan hits four stars and relaxes, it will fall out of that 4-star rating, according to Meinkow.

"Efficiencies always have to increase," Smith said. "The focus we find in a Medicare Advantage plan, is better quality and a better experience for a member and better care by provider networks."

Navigant helps health plans to close gaps, to move up to a new star rating level. 

There's no one recommendation, or one place to start, in getting started. 

"The most surprising thing providers find is, once they agree on an activities change, they are able to make that change and it's like a flywheel," Smith said. "Once they get it moving, it stays moving." 

The Navigant analysis of 500 Medicare Advantage contracts was done in collaboration with Columbia University Professor John McHugh.

NovuHealth also works with plans to increase star ratings.

"A high star rating offers a competitive advantage for a plan on multiple fronts in an increasingly competitive market," said NovuHealth CEO Tom Wicka. "For many of the plans NovuHealth works with, the higher CMS bonus--sometimes millions of dollars--can significantly strengthen a plan's performance."

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com