Eleven Medicare Advantage plans received top quality ratings for 2013 from the Centers for Medicare & Medicaid Services, up from nine plans in 2012, according to data released Oct. 12 on the agency's website.
The rankings are based on 48 quality measures, including preventive screenings, managing chronic conditions, and patient experience. CMS gives bonuses to plans for higher-quality ratings, which help restore some of the Medicare Advantage reimbursement cuts in the Affordable Care Act.
The MA plans that received an “overall” score of five stars for “excellent performance,” which includes both the plans' Part D drug rating and Part C health care rating, are:
• Group Health Plan Inc., Minnesota and Wisconsin;
• Group Health Cooperative, Washington state;
• Gundersen Lutheran Health System Inc., Wisconsin;
• Humana Wisconsin Health;
• Baystate Health Inc.'s Health New England, Massachusetts; and
• Kaiser Foundation Health Plans available in California, Hawaii, Colorado, Oregon/Washington, Ohio, and the Mid-Atlantic region.
According to CMS Deputy Administrator Jonathan Blum, the agency has been shifting to weighing outcomes and patient experience measures more than other measures.
CMS said Medicare beneficiaries in 2013 will have access to 26 four- or five-star prescription drug plans, which currently serve 18 percent of enrollees. This is an improvement from 2012, in which 13 four- or five-star plans are serving only 9 percent of enrollees.
CMS said beneficiaries will also have access to 127 four- or five-star Medicare Advantage plans, which will serve 37 percent of MA enrollees and may attract more with their improved quality ratings. In 2012, people with Medicare had access to 106 four- or five-star plans, which served only 28 percent of enrollees, CMS said.
The five-star rating provides bonus funds and additional marketing privileges to the highest-rated plans. Five-star plans receive payment bonuses of up to 5 percent additional reimbursement and 10 percent in certain “double bonus” counties.
Blum said CMS will continue to allow the highest-rated plans to market and enroll beneficiaries throughout the year. He said the agency will also make it difficult for beneficiaries to sign up for plans ranked at three stars or less. Those beneficiaries currently enrolled in low-ranked plans will receive notifications to let them know how they can change to a higher-quality plan if they choose to do so.
By Nathaniel Weixel
CMS's performance data files are at http://www.cms.gov/PrescriptionDrugCovGenIn/06_PerformanceData.asp.