Medicare Advantage appears to be performing better than in the past. All types of health care entities, including providers, have been trying to get a piece of the increasingly profitable insurance market that the rapidly-expanding program offers.
The case for optimism is based on a Thursday report released by the Centers for Medicare and Medicaid Services (CMS), which included its annual ratings of individual health plans that have contracts with the federal program.
The ratings, which have been released annually for the past ten years, grade insurers based on outcomes, patient experience and the access to care they provide. Insurers that receive at least a four out of five star rating are awarded with a 5 percent increase in the monthly money they receive per enrollee from the feds.
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In the most recent ratings, 179 of the 369 MA plans received a rating of at least a four out of five stars. That 48 percent represents an improvement over last year, when 40 percent of plans got at least four stars. The average rating also improved from 3.92 to 4.03.
The strong performers also account for an even greater percentage of enrollees. According to CMS, more than 70 percent of MA beneficiaries are covered by a program that has received at least four stars.
But there were also plenty of poor performers. Six plans could be terminated from the program after receiving ratings lower than three stars for three years in a row. The embattled plans come from WellCare Health Plans, Cuatro, Health Care Services Corp., Touchstone Health and UnitedHealth Group.
HealthLeaders Media reports that nonprofit plans continue to outperform for-profit insurers, with 70 percent of plans run by nonprofit insurers reaching the four star threshold, compared to 39 percent of plans operated by for-profits.
Perhaps the most prominent top performer: Kaiser Foundation Health Plans. Not only does the high rating mean more federal money for the nonprofit giant, but a valuable marketing pitch that will likely bring even more enrollees into its plans.
"You can't replicate Kaiser," John Gorman, a health care consultant and former CMS official, told Modern Healthcare. "Everybody's trying, but the reality of it is, there's no substitute for the vertical integration Kaiser's got."
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