More on Quality and Safety

CMS releases star ratings for Medicare Advantage and drug plans, Kaiser earns top marks

Overall, 73 percent of Medicare Advantage-PDP enrollees are in plans that have four stars or greater in 2018, CMS says.

Susan Morse, Managing Editor

Kaiser Permanente, Tufts Health Plan, and Anthem in New Hampshire are among 26 plans receiving 5 stars, the top rating for quality and performance in the Center for Medicare and Medicaid Services' 2018 star ratings for 633 Medicare Advantage and prescription drug plans.

The Centers for Medicare and Medicaid Services had 15 contracts that were high performing, with some, such as Kaiser, having more than one plan perform at 5 stars

No plans were listed as low performing.

HIMSS20 Digital

Learn on-demand, earn credit, find products and solutions. Get Started >>

[Also: See the list: CMS releases 2018 health plan star ratings]

But less than half, 44 percent, of Medicare Advantage plans that offer prescription drug coverage will get the 5 percent quality bonus payment for having an overall rating of four stars or higher in 2018.

This is an increase from 2017 when about 41 percent Medicare Advantage contracts had ratings of four or more stars, CMS said.

[Also: Expert calls CMS hospital star ratings delay a major mistake]

Approximately 52 percent of stand-alone Medicare Part D prescription drug plans will have a rating of four stars or higher in 2018, according to CMS.

Plans in lower scoring contracts receive no bonus.

[Also: CMS delays October star ratings release as advocacy groups push for major methodology overhaul]

Centene said it intends to appeal CMS's application of a penalty that lowered its 4 star rating to 3.5 for its Health Net of California Medicare Advantage plan.

The reduction is the result of a 2015 program audit in which CMS lowered a single measure, the Beneficiary Access and Performance Problem, because of a penalty associated with a plan audit in 2015, Centene said. While overall quality measures improved on a year-over-year basis, such improvement was insufficient to compensate for the lower BAPP measure.

"Our commitment to quality remains as strong as ever.  We are working to evaluate and mitigate the potential impact on the company's revenue in 2019 as a result of the lowered 2018 rating and working to implement year-over-year quality improvements.  We believe we will return to a 4.0 star parent rating in future periods," said Marcela Manjarrez-Hawn, senior vice president and chief communications officer.

In addition to lacking a bonus, lower performing MA plans are at a disadvantage for enrollment.

Close to three-quarters of consumers choose plans that have four stars or higher, according to CMS. In most areas of the country, consumers have access to a Medicare Advantage and Part D plans with four or more stars.

In 2018, about 73 percent of MA enrollees with prescription drug coverage will be in plans with four and five stars. This compares to 2017, when about 69 percent of these enrollees were enrolled in four and five star plans.

For Medicare Part D prescription drug plans, the number of enrollees in four or five star plans has increased from 41 percent in 2017 to 47 percent for 2018.

CMS Administrator Seema Verma said, for 2018, consumers heading into Medicare open enrollment starting Oct. 15 will see greater options and lower premiums.

The number of MA plans has increased from about 2,700 to 3,100, with more than 85 percent of people with Medicare having access to 10 or more Medicare Advantage plans.

The average monthly premium will decrease by about 6 percent from 2017, from an average of $31.91 to $30.

Premiums for a Medicare prescription drug plan in 2018 is also projected to decline for the first time since 2012, from $34.70 to $33.50 a month.

Anthem touted its significant improvement in star ratings for its MA health plan affiliates.

More than 60 percent of its Medicare Advantage members in 2018 will be in plans rated four stars or better, Anthem said. This compares to 2016 when 22 percent of members were enrolled in four-star or better plans.

In addition, 2018 marks the first time at least one of Anthem's affiliated health plans is rated five stars.

The company's affiliates will be offering five-star PPO plans in the New Hampshire, Georgia, and Kentucky markets. While Georgia and Kentucky health plans are not on CMS's five-star list, the agency's data reflects ratings as of today and not enhancements that Anthem and its affiliated health plans will make between now and moving into 2018, the company said.

The changes include evaluating contract structures to its Medicare business to ensure it is offering high-quality and high-performing plans. As a result of plan consolidation, the PPO plans in Georgia and Kentucky will carry the five star rating in 2018, Anthem said.

The 2018 ratings represent a new high in ratings for Anthem and its health plan affiliates since the start of CMS' Medicare star ratings program. Anthem said it aims to further improve the star rating performance of its health plans moving into 2019.

Anthem and its affiliated health plans have made considerable investments in the Medicare programs and expect meaningful growth in 2018.

"Over the last four years, Anthem has made a commitment to improve the performance and quality of our Medicare platform, ensuring we provide greater access to high-quality, affordable health care," said Anthem CEO Joseph R. Swedish.

Five star high performers were KelseyCare Advantage, six Kaiser Foundation Health Plans, Tufts Associated HMO, Blue Cross Blue Shield of Minnesota, CDPHP Universal Benefits, Medical Associates Clinic Health Plan, Gundersen Health Plan, Healthsun Health Plan, Optimum Healthcare, Anthem Health Plans of New Hampshire, Providence Health Assurance, two Dean Health Plans, Tufts Insurance Company, Healthpartners, Anthem's Blue MedicareRx, Excellus Health Plan and Wellmark's MedicareBlue Rx.

Star ratings are based on a plan's management of chronic diseases, the quality of customer service, and how well a plan handles customer appeals. Also included is measurement of prescription drug performance including pricing, safety and response to drug treatment.

Twitter: @SusanJMorse
Email the writer: