More Medicare Advantage plans have earned four stars or higher in the CMS Star Ratings program for 2014, increasing to 43 percent from 27 percent of plans in 2013, an Avalere analysis has found.
The Centers for Medicare & Medicaid Services Star Ratings performance program measures and reports a range of clinical and quality outcomes, such as diabetes management and medication compliance, member satisfaction and cancer screenings.
The CMS Star Ratings program offers a strategy to attract Medicare beneficiaries, who have some measures upon which to help them decide about their coverage during open enrollment, which ends Dec. 7.
The performance of Medicare Advantage plans has improved as they are making more investments "that look to be paying off" in quality, in anticipation of payment reductions due at the end of the Star ratings demonstration in 2015, said Matthew Eyles, Avalere vice president in a recent news release.
Next year, 1,042 plans will have four or higher stars compared with 700 such plans in 2013, according to the analysis of CMS data. Somewhat fewer Medicare Advantage plans will be available across the nation in 2014 – 2,429 – compared with 2,564 in 2013.
The Affordable Care Act connected plan payments to quality starting in 2012 by awarding bonus payments to those plans with ratings of four stars or higher. Then CMS began a pilot that expanded the use of quality bonus payments to plans with three to 3.5 stars until 2015, Avalere said.
Among Medicare Advantage plan market leaders, four star or higher plans make up 19 percent of UnitedHealthcare's MA plans and 36 percent of Humana's, according to an analysis of CMS plan data by HealthPocket.
UnitedHealthcare had 40 percent of its plans receive three stars or lower, while Humana had 14 percent at that level. The industry as a whole had 29 percent of plans at three stars or lower.
"The distribution of plans in the lower ranking categories is diminishing," said report author Steve Zaleznick, executive director for consumer strategy and development at HealthPocket.
Cigna's HealthCare of Arizona HMO plan, with 4.5 stars out of five, is an example of plans that have focused on improving its scores in certain areas, including disease early detection and prevention, patient safety, disease management and customer service.
Its medication therapy management program, which scored high, is offered to those taking multiple medications, have multiple chronic conditions or high annual drug costs. The program helps customers take advantage of their drug benefit and encourages them to meet with a plan pharmacist to make sure that they are taking their medications correctly, said Edward Kim, president of Cigna in Arizona, in a news release.
Products that can help plans analyze their data, provide an infrastructure to enable coordinated interventions and pinpoint quality gaps can boost Star Ratings scores, according to Inovalon, a healthcare technology company. Health plans must continually innovate and use healthcare data "to analytically drive higher levels of quality improvement," said Keith Dunleavy, MD, Inovalon CEO in a news release.
The Avalere report also found that significantly more counties – 51 percent more – will have access to a plan of four stars or higher in 2014, although fewer counties, 133, will have five-star plans next year compared to the 252 in 2013.
This year, 13 states and the District of Columbia had a five-star plan available. Although 12 states and DC have a five-star plan in 2014, some of the states have changed from this year. While Illinois, Massachusetts, Minnesota, and Ohio all lost five-star plans in 2014, Florida, Georgia, and Texas gained the option. California, Colorado, Hawaii, Iowa, Maryland, Oregon, Virginia, Washington and Wisconsin have maintained their five-star plans.