By Maria
Castellucci | October 11, 2017
The CMS' release of its
Medicare star ratings reveals that performance among insurers overall in
Medicare Advantage remains largely unchanged year-over-year.
The latest data, released Wednesday, show that the number of Medicare Advantage plans that performed well in the CMS' star ratings program dropped slightly from last year. At the same time, the amount of insurers that receive certain ratings hasn't changed significantly in recent years.
The CMS said about 44% of the 384 active Medicare Advantage contracts in 2018 that also have Part D prescription drug coverage earned 4 stars or higher for their overall rating. This is a drop from 2017 when about 49% of the 363 active Medicare Advantage plans earned 4 stars or higher.
Although the overall number of 4-star or high plans dropped slightly, more beneficiaries will be covered by the highest performing Medicare Advantage plans in 2018, the CMS said. Nearly 73% of Medicare Advantage enrollees are in contracts with 4 or more stars, compared to about 69% of enrollees in such plans last year.
The data also reveal that the number of insurers designated certain stars hasn't changed much in the last few years. In 2015, 136 Medicare Advantage contracts with Part D prescription drug coverage earned a 3.5 star rating. In 2018, 139 contracts had the same star rating. The number of contracts in 2015 with a 4-star rating was 86 and in 2018 the figure rose to 98.
The gold star performers — contracts that have earned a five star — remained unchanged from last year at 23.
Another consistent trend is that higher performers tend to be companies that have the most experience in Medicare Advantage. Contracts with more than 10 years in a Medicare Advantage program accounted for about 21% of 4.5-star ratings and 31% of 4-star and 3.5-star ratings.
The CMS began its star rating system for Medicare's private insurance coverage about a decade ago as a way to encourage insurance companies to provide high quality care to Medicare beneficiaries. Companies are assigned a star rating on a scale of one to five. Many measures determine the composite score, including those involving the care process.
Richard Lieberman, chief data scientist at Mile High Healthcare Analytics, said it's not surprising that the figures have remained largely stagnant in recent years. Insurers that invested in the infrastructure and culture to improve quality of care did so years ago and continue to perform at 4 stars or higher, he said. On the other hand, some insurers still haven't made the investments to get to achieve higher performance.
"There are those plans that focus on it … and there are others that can't do it," he said. "I think 73% on an enrollment weighted basis is probably where it is going to be."
CMS also makes it harder every year to perform well on the various measures, which pushes out bad performers from the program, Lieberman said. Just 12 contracts in 2018 have 2.5 stars while 61 have 3.
Plans that earn at least four stars receive a 5% boost to their monthly per-member payments from Medicare, while those with lower scores receive nothing extra. The CMS bonus for a lot of plans is the "difference between profitability and not," Lieberman said.
The bonuses have allowed insurers to foster plans with additional benefits that are appealing to beneficiaries.
In addition, the CMS found that the number of Medicare Advantage contracts with dual Part D prescription drug coverage rose by 21 from 2017 to 2018. Medicare Advantage contracts have become a lucrative revenue opportunity for insurers with many increasing enrollees in such plans.
"More high-quality choices mean improved quality care and better customer service at lower cost. Medicare open enrollment begins soon and the star ratings helps people with Medicare shop to find the best choice possible," said CMS Administrator Seema Verma in a press release.
Unlike the dual Medicare Advantage and Part D contracts, the number of Part D plans declined from last year from 59 to 55 in 2018. For enrollees in Part D plans, 47% will be in contracts with 4 or more stars in 2018.
No insurers were labeled consistently low performers for the first time. Low performers — contracts with ratings of 2.5 or fewer stars for three years in a row — can be terminated from the CMS program. Only two contracts — Phoenix Health Plans and GHS Managed Health Care Plans — were low performers in 2017.
Anthem touted its high star ratings Wednesday. The Indianapolis-based insurer said in a news release that more than 60% of its Medicare Advantage members will be in enrolled in plans with four stars or higher.
Humana, which saw its plans with four stars or higher drop in 2017, said its number of four-star plans increased for 2018. Humana has 12 contracts with a rating of 4 stars or higher, representing 74% of its 3.3 million Medicare Advantage members.
St. Louis-based Centene saw a drop in its star rating from 4 stars to 3.5 for 2018. The insurer said that its Medicare Advantage plan Health Net of California's continues to suffer from a 2015 performance audit. The penalty will only impact the 2018 star rating and it intends to appeal the decision, according to a news release.
The latest data, released Wednesday, show that the number of Medicare Advantage plans that performed well in the CMS' star ratings program dropped slightly from last year. At the same time, the amount of insurers that receive certain ratings hasn't changed significantly in recent years.
The CMS said about 44% of the 384 active Medicare Advantage contracts in 2018 that also have Part D prescription drug coverage earned 4 stars or higher for their overall rating. This is a drop from 2017 when about 49% of the 363 active Medicare Advantage plans earned 4 stars or higher.
Although the overall number of 4-star or high plans dropped slightly, more beneficiaries will be covered by the highest performing Medicare Advantage plans in 2018, the CMS said. Nearly 73% of Medicare Advantage enrollees are in contracts with 4 or more stars, compared to about 69% of enrollees in such plans last year.
The data also reveal that the number of insurers designated certain stars hasn't changed much in the last few years. In 2015, 136 Medicare Advantage contracts with Part D prescription drug coverage earned a 3.5 star rating. In 2018, 139 contracts had the same star rating. The number of contracts in 2015 with a 4-star rating was 86 and in 2018 the figure rose to 98.
The gold star performers — contracts that have earned a five star — remained unchanged from last year at 23.
Another consistent trend is that higher performers tend to be companies that have the most experience in Medicare Advantage. Contracts with more than 10 years in a Medicare Advantage program accounted for about 21% of 4.5-star ratings and 31% of 4-star and 3.5-star ratings.
The CMS began its star rating system for Medicare's private insurance coverage about a decade ago as a way to encourage insurance companies to provide high quality care to Medicare beneficiaries. Companies are assigned a star rating on a scale of one to five. Many measures determine the composite score, including those involving the care process.
Richard Lieberman, chief data scientist at Mile High Healthcare Analytics, said it's not surprising that the figures have remained largely stagnant in recent years. Insurers that invested in the infrastructure and culture to improve quality of care did so years ago and continue to perform at 4 stars or higher, he said. On the other hand, some insurers still haven't made the investments to get to achieve higher performance.
"There are those plans that focus on it … and there are others that can't do it," he said. "I think 73% on an enrollment weighted basis is probably where it is going to be."
CMS also makes it harder every year to perform well on the various measures, which pushes out bad performers from the program, Lieberman said. Just 12 contracts in 2018 have 2.5 stars while 61 have 3.
Plans that earn at least four stars receive a 5% boost to their monthly per-member payments from Medicare, while those with lower scores receive nothing extra. The CMS bonus for a lot of plans is the "difference between profitability and not," Lieberman said.
The bonuses have allowed insurers to foster plans with additional benefits that are appealing to beneficiaries.
In addition, the CMS found that the number of Medicare Advantage contracts with dual Part D prescription drug coverage rose by 21 from 2017 to 2018. Medicare Advantage contracts have become a lucrative revenue opportunity for insurers with many increasing enrollees in such plans.
"More high-quality choices mean improved quality care and better customer service at lower cost. Medicare open enrollment begins soon and the star ratings helps people with Medicare shop to find the best choice possible," said CMS Administrator Seema Verma in a press release.
Unlike the dual Medicare Advantage and Part D contracts, the number of Part D plans declined from last year from 59 to 55 in 2018. For enrollees in Part D plans, 47% will be in contracts with 4 or more stars in 2018.
No insurers were labeled consistently low performers for the first time. Low performers — contracts with ratings of 2.5 or fewer stars for three years in a row — can be terminated from the CMS program. Only two contracts — Phoenix Health Plans and GHS Managed Health Care Plans — were low performers in 2017.
Anthem touted its high star ratings Wednesday. The Indianapolis-based insurer said in a news release that more than 60% of its Medicare Advantage members will be in enrolled in plans with four stars or higher.
Humana, which saw its plans with four stars or higher drop in 2017, said its number of four-star plans increased for 2018. Humana has 12 contracts with a rating of 4 stars or higher, representing 74% of its 3.3 million Medicare Advantage members.
St. Louis-based Centene saw a drop in its star rating from 4 stars to 3.5 for 2018. The insurer said that its Medicare Advantage plan Health Net of California's continues to suffer from a 2015 performance audit. The penalty will only impact the 2018 star rating and it intends to appeal the decision, according to a news release.
Maria
Castellucci is a general assignment reporter covering spot news for Modern
Healthcare’s website and print edition. She writes about finances, acquisitions
and other healthcare topics in markets across the country. Castellucci is a
graduate of Columbia College Chicago and started working at Modern Healthcare
in September 2015.
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