Dive Brief:
- Eighty-one companies covering 179 individual health plans, about half of all plans for 2016 received at least 4 stars as per Modern Healthcare's analysis of 2016 Medicare Advantage star-rating data. In 2015, only 40% of all plans received 4 stars.
- Star ratings include clinical outcomes, patient experience, and access to care. Plans that earn 4 stars receive a 5% increase to their monthly per-member Medicare payments. Plans with lower scores receive no extra payments.
- There were six plans that are eligible for termination from Medicare because of not earning at least three stars in the past three years. WellCare Health Plans owns two of these plans. Cuatro, Health Care Service Corp., Touchstone Health and UnitedHealth Group manage the other plans.
Dive Insight:
Part D Plans did not score as well and have averaged 3.4 stars versus 3.75 stars last year. Problems are from outdated technology that automatically rejects prescriptions, John Gorman, a former CMS official and Washington-based health insurer consultant told Modern Healthcare.
Insurers with retail pharmacy partners, like CVS or Target, can better improve their quality scores because of their pharmacy convenience. CMS has levied millions of dollars in fines on Medicare insurers tied to pharmacy benefit violations. Lawmakers have tried to save health plans and Rep. Vern Buchanan (R.-Fla) introduced a House bill that would temporarily delay CMS's ability to end Medicare Advantage plan contracts based on their star ratings.
However, Gorman says he doesn't see the bill passing and CMS could have previously helped the six agencies eligible to be terminated, but the agency "handed out squirt guns to the firing squad because they don't want disruption in an election year."