Now that the star ratings program run by the U.S. Centers for Medicare and Medicaid Services (CMS) is a formal program and no longer a demonstration, health plans need to quickly adjust to the program’s new and more stringent requirements.
“In January, CMS will only award payments to plans with ratings of four stars or higher,” says Mike Burgin, vice president and general manager of clinical and quality outcomes at Inovalon, a data analytics company in Bowie, Maryland. “That is likely to have a significant and adverse effect on the financials of any plan that does not meet that threshold.”
This is especially true as continued pressure on Medicare payments reduces plans’ already thin profit margins. “Many plans are profitable or unprofitable based on this bonus,” Burgin says.