Editor's note: Press Ganey has retracted this analysis. We will update the story when new data is available.
More than 80% of Medicare Advantage plans are in danger of losing at least one star in one or more of their ratings for 2023, potentially imperiling millions in quality bonuses for plans, a new analysis finds.
The analysis, released last week from Press Ganey, found that nearly half of MA plans are at risk of losing a star, which estimates how easy it is for seniors to get prescription drugs under the plan. The loss in stars is due to lower ratings from members and higher performance cut points, Press Ganey said.
“Declining in Star Ratings poses serious financial implications—resulting in millions and in some cases billions, of dollars—that will directly impact member benefits and member retention,” said Suzanne Cogan, general manager of payer solutions for Press Ganey.
MA plans are evaluated based on a rate of one to five star ratings for several quality measures and are based on patient satisfaction and other quality indicators such as screenings.
The analysis from Press Ganey, which can conduct experience surveys from plan members, is based on preliminary 2022 data from 446 MA plans. It showed that 48% of MA plans are at risk of losing a star on the measure of getting needed prescription drugs, while 44% are at risk of losing one due to customer service and for care coordination.
Plans also must face new changes in how star ratings are calculated for 2023. The Centers for Medicare & Medicaid Services puts a certain weight on data from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys that evaluate patient experiences.
Due to a final rule released in 2020, there are several CAHPS measures that have a greater emphasis on star ratings for 2023.
Some of the measures that were weighted a two in 2022 will be a four next year, including:
- Customer service
- Getting needed prescription drugs
- Rating of drug plan
- Care coordination
- Rating of healthcare quality
Press Ganey’s preliminary findings could harm finances for a growing and lucrative market for insurers, as plans have been receiving higher bonuses in recent years.
From 2015 through 2021, the annual bonuses to MA plans rose from $3 billion to $11.6 billion, according to data from the Kaiser Family Foundation.
“The rise in bonus payments is due to both an increase in the number of plans receiving bonuses and an increase in the number of enrollees in these plans,” the organization said in an analysis.
MA enrollment has grown this year to represent 45% of all Medicare enrollment, a study from the Chartis Group found. Other projections expect MA enrollment to make up more than half of all Medicare enrollment in the coming years.