Low Medicare Advantage Star Ratings in 2011 Have Pushed Healthcare Plans to Improve Their Measures in Arizona, Colorado and Nevada, According to New Health Plan Analysis from
HealthLeaders-InterStudy

February 8, 2012—Nashville, Tenn. —HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that low Medicare Advantage star ratings in 2011 and potential for lost revenue have pushed many plans in the West to improve their measures. Motivated by the impact of star ratings on reimbursement, many Medicare Advantage plans in Arizona, Colorado and Nevada have dramatically improved their ratings, according to the West Health Plan Analysis.

The Centers for Medicare and Medicaid Services (CMS) rates the quality of Medicare Advantage providers by using 36 standard performance measures that are each given a star rating. The CMS then averages the star ratings to come up with an overall score for the provider. These ratings are used to determine reimbursement rates for Medicare Advantage providers.

Some plans in Arizona, Colorado and Nevada that already high start ratings were able to hold on to their successful scores. For example, Kaiser Permanente Colorado held onto a five-star rating for the second straight year, according to the report. The West region also experienced growth in plans rated 3.5 stars and above.

According to the report, top-scoring Medicare Advantage plans in the West scored well in chronic disease care, which is a likely indicator of successful drug adherence initiatives.

“Because of more assertive disease management and preventive screenings, top plans could see an increase in drug utilization,” says Bill Melville, market analyst with HealthLeaders-InterStudy.

The West Health Plan Analysis also answers the following key questions:

• What impact will Kaiser Permanente's northern Colorado expansion have on that state's market?
• How has premium pricing impacted employer groups in the Las Vegas and Reno markets?
• What will ratings mean for plans' marketing and benefit offerings?
• Will low ratings force carriers from Medicare Advantage markets in the West?

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