CMS Star Quality Ratings: Shifting Strategies for Medicare Advantage and Part D Plans and Providers

Table of Contents

New Measures Under Consideration, and Those Adopted and Retired

• CMS Will Stress Outcome Measures in New Star Ratings, Won’t Adjust for Region
• CMS Is Seen Giving Higher Star Weights to Clinical Items in Wake of Plan Comments
• CMS Unveils Specific Star-Rating Measures to Add, ‘Retire’; Changes May Cut Scores
• Updated CMS Star-Rating Changes Delay Some Shifts, but Not Most
• CMS Proposes ‘Benign’ MA/Part D Rule, Letting It Cut Plans, Delve Into Contracts
• CMS Unveils Planned 2013 Star-Rating Changes, Including Improvement Measure

Plans That Are Stars Winners and Losers

• Far More MA Plans Get Top Star Ratings for 2012; Six Kaiser Units Get Five Stars
• Stars Winners Include Humana, United; Universal American Loses
• Essence Cites Star Ratings, Luring Medigap Enrollees for AEP Gains

Strategies for Boosting Star Ratings

• MA Plans Looking to Boost Star Ratings Form Burgeoning Market for Data Vendors
• MA Plans Look to OTC Benefits to Boost Enrollment, Star Ratings
• Drug Measures Hurt Star Ratings for MA Plans, Require Closer Ties

Financial Aspects of Star-Rating Bonuses

• Quality Bonus Will Aid Plans Mainly Through Rebates, Not Big Payments
• CMS Lowers 2012 Pay Rates in Final Notice, but Proceeds With Extending Quality Bonus
• CMS Escalates Its Use of Letters Seeking CAPs From MA Plans With Low Star Ratings

Written By

This book was written by the editorial staff of AIS.

Written For

• Health plan CEOs, CFOs, chief operating officers, government affairs and compliance directors, marketing executives, medical and clinical services managers, directors of provider relations, contracting executives, product directors, accountants and actuaries.
• Hospital and medical group CEOs, CFOs, administrators and directors of managed care contracting
• Pharmaceutical company and PBM executives
• Insurance agents, brokers and third-party administrators
• Health information technology company executives and marketing directors
• Attorneys, consultants and actuaries

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