Raising the Bar for Standards on Medicare Advantage Stars and Focusing on the Consumer

November 1, 2022

by Michael Bagel

Medicare Advantage (MA) is the choice of America’s seniors. Over the past ten years, enrollment has risen dramatically, eclipsing more than half of all seniors this year, driven principally by the widespread availability of high-quality and affordable options. Enrolling a high proportion of seniors in high quality MA plans is worthy of celebration. However, surveys continue to find that only 15 percent of consumers use quality star ratings to select health coverage. Yet, 74 percent of seniors say that they would likely use star ratings if they could have access to that educational information. It is an unacceptable shortcoming that seniors do not have the tools and education they need to use quality ratings in selecting the coverage best for them.

The prevalence of highly rated health plans currently on the market has inhibited a critical investment to advance informed consumerism. During Medicare’s Open Enrollment season, we must help consumers shop for health plan coverage that aligns individual consumer affordability and quality considerations. Whether it is consumer experience, patient outcomes, satisfaction with your health plan or another measure, every senior should be encouraged to consider the quality performance of the plan they are selecting.

It is time to raise the bar on MA quality. We have done it before, and it is past time we did it again. When star ratings first began, only a quarter of seniors were enrolled in a high-quality plan. Within a decade, that percentage has tripled. While this is a noteworthy accomplishment, we cannot be content. If most health plans are achieving above-average quality, the standard must be raised. We cannot lose our commitment to delivering and achieving high quality.

Current MA star ratings have too many measures, unnecessarily prioritize process along with customer experience and health outcomes and fail to reward consistently high performance. To increase consumer use of quality metrics in health coverage decision-making, we must streamline the number of measures, focusing on those most meaningful to consumer experience and positive health outcomes. For comparison purposes, we must make it easier for consumers to compare the quality performance of the health plan options available in their geography, meaningfully comparing offerings tailored to each consumer’s circumstance. It will always be easier to add new measures than to simplify. Putting the consumer first means giving up measures that prop up star ratings without driving superior experience and better health outcomes.

Representing the nation’s top-performing non-profit health plans committed to affordability and outcomes in the health care system, the Alliance of Community Health Plans (ACHP) knows first-hand the investment and resources required to advance high-quality care. We are proud that more than one-third of all consumers nationwide in top-quality plans are enrolled with an ACHP member company, despite ACHP members representing only ten percent of total MA enrollment. We are uniquely situated to advance the reimagining of the MA star system to raise the bar for achieving high quality and increasing consumer education to make informed health care plan selection decisions. And if we are willing to come forward and call to raise the bar, others should too. It is our duty, and we will continue to lead the way.