Despite rate pressures and a funding gap, insurers remain bullish on Medicare Advantage. To maintain their MA product revenue stream, insurers are embracing care coordination, investing in clinical quality improvements, and implementing value-based rewards for physicians and healthcare systems.
WellPoint is in the process of evaluating the MA markets it serves, capturing risk score revenue, and improving its star ratings.
The Medicare Advantage star program plays an important role in the MA strategy with insurers committing resources to improve their star ratings. Now in its sixth year, the ratings program was created by CMS to monitor health plan quality and performance.
Billions of dollars in bonus payments are shared by plans that achieve at least three stars because five-star plans—there are only 14 in 2014—can enroll members throughout the year rather than for the short, seven-week open enrollment period each fall.
Cigna, whose HealthSpring of Florida plan scored one of the elusive five-star ratings, cites its physician engagement model, which rewards improved health outcomes, customer value, and patient engagement.