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Recent Industry News

Federal Health Care Programs

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The Centers for Medicare & Medicaid Services (CMS) recently published the Part C and D Star Ratings to measure quality in Medicare Advantage (MA) and Prescription Drug Plans (PDPs).  CMS publishes results annually to determine MA Quality Bonus Payments and assist beneficiaries in finding a suitable plan.  The Star Ratings measure intermediate outcomes, patient experience, access, and process.  Further, CMS uses the data to improve the degree of accountability for the care offered by physicians, hospitals, and other providers.  This year, roughly half of the 364 MA plans with prescription drug benefits (MA-PDs) earned 4 stars or higher out of the 5-star rating system.

Key details from the CMS ratings include the following:

  • Over two-thirds of MA-PD enrollees are in contracts having four or more stars;
  • Over 90 percent of MA-PD enrollees are in contracts with ratings of 3.5 or more stars;
  • Currently, 23 contracts are considered high-performing; and
  • This year saw 12 new 5-star contracts.

Further, two Part C contracts were considered low-performing for receiving consistently low quality ratings, and could face termination of their contracts with Medicare in 2017 if the ratings do not improve.

The Medicare Parts C and D Performance Data are available at:

https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/PerformanceData.html.

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