This year brought significant codified changes to the Medicare Advantage Star Ratings program as part of CMS’s effort to reduce overspending and ballooning bonus payments – and the healthcare industry is seeing how this makes historically high Star Ratings more difficult to achieve. Smaller plans looking to grow their memberships will find it increasingly difficult to innovate and offer competitive benefits without the help of bonus payments, and plans that receive three stars or less for more than two years also stand to have their contract and expansion applications denied by CMS beginning in 2023. Now is a critical time for plans to prioritize interoperability and real-time electronic prior authorization resources that affect Consumer Assessment of Healthcare Providers and Systems (CAHPs) ratings. Looking ahead, we are likely to see more plans adopt technology that ensures people receive the care they need and get the benefits they expect.
- Cynthia Henry, Manager, Medicare Advantage Solutions, ZeOmega

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