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Don't leave money on the table: Improve your Medicare Advantage quality rating


Dina Overland

Not improving your Medicare Advantage star quality rating is like leaving money on the table and walking away; it just doesn't make sense. I reached that conclusion after speaking with L.E.K. Consulting's Joe Johnson, who laid out a clear explanation of why the Medicare Advantage 5-Star Quality Rating System, in particular, is beneficial for insurers and why improving overall quality care is also worth the time, resources and financial commitment necessary to reap big rewards.

Through its quality ratings, Medicare Advantage pays bonuses to private insurers that receive 3 to 3.5 stars out of 5 on Medicare's rating scale, which includes more than 50 measures from five different rating systems.

By simply improving from a 3-star to 4-star rating, insurers can accrue an additional $50 per member per month, on average.

"There are certainly benefits when it comes to the revenue generation standpoint," Johnson, who is senior manager with L.E.K.'s healthcare services practice, told FierceHealthPayer.

Many health plans have embraced the Medicare Advantage star quality program. "They are making bets and doubling down on efforts internally to support star quality ratings," he said.

But if you think quality improvement is only for Medicare Advantage plans, think again. "We're going to start to see quality take hold in other elements of healthcare delivery" as the entire health insurance industry ramps up its focus on improving quality care, such as the patient-centered medical home or accountable care organization, according to Johnson.

In other words, if you're not already on the quality improvement train, it's time to get aboard.

So how can a health plan improve its Medicare Advantage star rating and its ability to ensure quality care overall? Johnson says the first step is to understand that because Medicare's star rating criteria aren't all created equal, insurers must "identify and target the specific star measures that could contribute in the most meaningful way to their overall scores."