Beyond the added bonus payment, a 3 to 4-star improvement can generate 134 percent more value to its members in extra benefits through more generous rebates.

HCB News: What can MA plans do to not only increase their star ratings, but also enrollment and revenue?


JS: For starters, they must consider the role of providers. Strong star ratings are partially a result of contracting with providers that invest time and resources into closing care gaps to improve care quality and satisfaction. Therefore, plans should proactively seek collaborative arrangements with providers to share the financial benefits of quality and efficiency improvements, ultimately leading to greater plan satisfaction and quality among all involved.

Recently, payers faced ambivalence from providers about joining MA networks because participation did not offer additional revenue opportunities. Moreover, value-based models were only beginning to be negotiated broadly in commercial and MA areas. Now, given the shift to value and comparatively less attractive commercial revenue streams which have flattened or eroded in recent years, providers may be more receptive to considering participating in MA networks under value-based arrangements.

MA plans rely on sufficiency of enrollment to maintain their ongoing viability. Increases in star ratings can have an immediate effect on the MA plans’ bottom line through growth in enrollment, revenue and market share. Ratings improvements can also drive increased rebates that plans can use to enhance benefits, increasing the likelihood of beneficiary re-enrollment or new beneficiaries joining the plan.

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