It's not a static process. According to a consultant who works with Medicare Advantage demo clients, the star program gets tougher each year. Quality measures change as a majority of healthy plans achieve competencies, explains Nathan Goldstein, CEO of Gorman Health Group, a Medicare managed care consulting firm in Washington, DC. Health plans will need to work very hard just to maintain their star rating; moving up will require a concerted effort.
And no slacking will be allowed. Goldstein says CMS has made it clear that it will systematically eliminate poor performers (fewer than three stars) from the MA program.
CMS seems to have developed an effective carrot (bonus) and stick (termination) plan that has engaged the health plan industry. Calling for the program to end really seems like overkill.