The CMS star rating system is based on 48 quality measures for Medicare Advantage plans with prescription drug programs (MA-PD) and 36 measures for MA plans without a drug plan. The measures fall into several broad categories, including health screenings, managing chronic conditions, and member satisfaction.
In addition, making the grade often depends on how common managed care is in a geographic area. "It's not just the actions by the health plans, although that's certainly the most important element," says Eyles. "But you have to have providers who are your partners, who understand what drives quality, and who do what they are supposed to do to drive those high star ratings."
Eyles says that overall the 2014 star ratings show improvement among the 3- and 3.5-star plans. "CMS is pushing plans and the plans are clearly responding. They have been making investments in quality and improving those star ratings. Their investments are paying off. It's an intensive effort to focus on improving and to actually be able to implement the systems, programs, and outreach with beneficiaries, to make a meaningful difference one year to the next.
For the 2014 plan year, the number of 4- and 4.5-star plans available increases to 151 from 116 the previous yea. Moving from three to four stars is important because in 2015 the minimum rating to qualify for a bonus will be four stars.
"The bonus can be the difference between an MA plan making money or not, says Eyles.