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By Mindy Yochelson
Nine Medicare Advantage plans received top quality ratings for 2012 from the Centers for Medicare & Medicaid Services, three times as many as in 2011, according to data released Oct. 12 on the agency's website.
The rankings, based on care and service quality measures across five categories, are made at the specific plan or contract level.
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:
• Baystate Health Inc.'s Health New England, Massachusetts;
• Group Health Cooperative, Washington state;
• Gundersen Lutheran Health System Inc., Wisconsin;
• Marshfield Clinic's Advocare, Wisconsin;
• Martin's Point Health Care Inc.'s Generations Advantage, Maine; and
• four Kaiser Foundation Health Plans, marketed as Kaiser Permanente Senior Advantage, and available in California, Hawaii, Colorado, and Oregon/Washington.
Jonathan Blum, CMS's deputy administrator and director of its Center for Medicare, told an industry conference in September that there would be a few more top-rated plans in 2012 than the three five-star plans in 2011 (see previous article).
The three plans with top ratings in 2011 were the Marshfield plan and the Kaiser plan in Colorado, as well as Capital Health Plan, part of Blue Cross Blue Shield of Florida.
The nine in 2012, all health maintenance organizations, have a wide range of enrollment—from 797,669 for the Kaiser plan in California to 5,349 for Baystate Health.
“The Medicare star quality rating system encourages health plans to improve care and service, leading to better patient experiences across the board,” Jed Weissberg, a senior vice president at Kaiser Permanente, said in an Oct. 12 statement about his company's four plans.
“Our organization maintains an ongoing commitment to quality that is shared by our physicians and employees who provide care and service to our members each day,” Weissberg added.
Larry Henry, a vice president at Martin's Point, said in a statement that “the advantages our plans will receive as a result of the five-star rating will help us continue to improve our ability to provide our members with industry leading quality and serve as a competitive advantage moving forward.”
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.
The 2012 plan quality results will be used for 2013 reimbursement.
The five-star plans also receive “high performer” or “gold star” icons in their listings on Medicare's Plan Finder and are allowed to market to beneficiaries during the entire year. Medicare beneficiaries may switch to an available five-star plan at any time.
For other plans, the Medicare open enrollment period, in which beneficiaries are allowed to enroll in plans, begins on Oct. 15 and lasts seven weeks to Dec. 7.
Barclays Capital Equity Research said in research released Oct. 12 that the overall MA rating for 2012 was 3.56 stars, up 0.11 star over the last year.
CMS's performance data files are available at http://www.cms.gov/PrescriptionDrugCovGenIn/06_PerformanceData.asp .
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