Health Reform: CMS Star Rating System is the New Risk Adjustment

Read the next in GHG's series of Executive Briefings, CMS Star Rating System is the New Risk Adjustment. Included is a health reform timeline highlighting critical MA and Part D implementation dates.  

Under the Health Care Reform legislation, payment to Medicare Advantage plans is linked to a beneficiary’s experience and quality of care. For the first time, high performing plans will be paid more than lower performing plans. This changes the terms of market competition and turns incentives in Medicare Advantage towards improving quality.

It’s comparable to the full phase-in of risk adjustment in 2007, which turned attention from avoiding sick beneficiaries to enrolling all beneficiaries regardless of health status. With the CMS star rating system as the new industry rallying point, plans can realize substantial payment increases by improving quality.

 To read more, click here.

To access the CMS Medicare Health Plan Quality and Performance Ratings Technical Notes, click here.