Under the Affordable Care Act, the government is reducing Medicare Advantage payments to a level closer to traditional fee-for-service Medicare. The plans can compensate for those cuts by showing an ability to coordinate care, manage chronic illness and respond to customer queries. The plans are judged based on Healthcare Effectiveness Data and Information Set quality measures and given a 1-5 star rating.
The measurement and stars were developed in 2007, but interest in the program spiked with CMS introduced financial bonuses. Five-star plans can receive bonuses of up to 5 percent additional reimbursement, and up to 10 percent in “double bonus” counties.
Some plans are enlisting physicians’ help in providing feedback through data. The data will help identify gaps in care related to prevention, wellness or chronic disease. Experts say health plans may pass along some financial gains to those physicians who make an effort to participate.
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