One federal strategy to improve healthcare is to strengthen the link between patient care outcomes and reimbursement levels. To that end, the Centers for Medicare & Medicaid Services (CMS) has established its 5-Star Quality Rating System, which provides Medicare Advantage (MA) plans with quality rating metrics and associated bonus payment criteria. MA plans can capture significant incremental revenue by meeting certain thresholds through CMS’ star rating system.

L.E.K. Consulting has outlined its approach to becoming a rising “star” in a report to help health plans capture added performance incentives while helping to improve healthcare delivery. The report includes:

  • How to quantify the value of high MA star quality ratings
  • A three-step approach to improve your health plan’s star ratings:
      - How to identify the most influential star ratings criteria scores to change
      - How to compare relative “contribution” across cohorts
      - How to rank the improvement opportunities
  • Practical examples for improving star ratings
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