Medicare star quality management: Charting a path to higher ratings

The centers for medicare and medicaid services (CMS) is committed to achieving the 13 to 14 percent nationwide cuts outlined in the affordable care act (ACA), which will hit plans fully by 2017. In an industry where many plans operate with margins in the low single digits, any reduction is a daunting figure. One of the most promising strategies to offset this loss of revenue is to capture bonus payments from the five-star quality rating system, which can reduce the cuts from 14 percent to 9 percent if a health plan achieves at least a 4-star overall rating. Improving performance to capture these bonuses won’t be easy, but the rewards will be significant.