CMS working on star-rating system for Medicare-Medicaid plans


The federal government is working to create a star-rating system that lets users rate and compare Medicare-Medicaid plans (MMPs), and in the meantime it will make quality data available about the plans.

memo from the Centers for Medicare & Medicaid Services (CMS) outlines the strategy of the Financial Alignment Initiative system for MMPs, which CMS says will be "robust enough to serve as a potential basis for quality-based payments for plans that would promote value-based payment systems, improved care coordination and enhanced population health."

While the star-rating system will not be in place during its testing period, CMS will make the quality data on health plans participating in its dual-eligibles demonstration program available starting in 2016.


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CMS already uses a star-ratings system to rate Medicare Advantage (MA) plans. What's more, previous research has linked higher star ratings with greater enrollment in MA plans, as consumers increasingly choose plans with four or more stars. But the health insurer WellCare has criticized the MA ratings system, saying it puts insurers with a high proportion of dual-eligible members at a disadvantage.

According to the memo, once the program is complete, the MMP rating system will measure quality across the full spectrum of Medicare and Medicaid services, reflect the care and quality-of-life goals of the populations served by MMPs, build on the strengths of the existing MA and Part D star ratings and maximize consistency across states.

For the Medicare-Medicaid population, the initiative would further CMS' goal to make care for these groups safer, strengthen patient engagement, promote effective communication and care coordination and deliver more affordability, according to the memo.

To learn more:
- read the CMS memo


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