Refining Medicare Advantage Star Ratings Policy Considerations

This whitepaper outlines the Medicare Advantage (MA) Star Ratings program, which was established in 2007 to evaluate the quality of MA plans based on performance metrics. The Centers for Medicare & Medicaid Services (CMS) assigns Star Ratings to plans, which range from 1 to 5 stars, with higher ratings linked to increased payments aimed at incentivizing quality improvement. The document details the scoring methodology, including the sources of data used for evaluation, such as the Health Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). It also discusses the distribution of Star Ratings among plans, the impact of quality bonus payments and rebates on plan funding, and recent policy changes affecting the program. The whitepaper concludes with an overview of proposed modifications to the Star Ratings program, reflecting ongoing efforts to enhance quality assessment in Medicare Advantage.