16 Aug Medicare Advantage Quality Bonus Payments to Reach $12.8 Billion

Reinforces Need for Data-Driven Solutions for Enhancing Star Ratings

According to a recent detailed analysis from the Kaiser Family Foundation (KFF), Medicare Advantage bonus payments will reach at least $12.8 billion in 2023, which is an increase of nearly 30 percent from last year.

In addition, total spending on Medicare Advantage plan bonuses has quadrupled since the program launched in 2015. In 2023, 26 million people, or 85 percent of Medicare Advantage enrollees, are in plans that receive bonuses. The share of enrollees in plans that receive bonus payments is also at an all-time-high at 75 percent.

The report also found that average annual bonus payments are highest for enrollees in employer- and union-sponsored plans. UnitedHealthcare and Humana together account for 47 percent of Medicare Advantage enrollment, and are expected to receive 49 percent of total bonus payments in 2023.

An increasing share of Medicare Advantage enrollment in plans with at least a 4-Star quality rating is driving much of this overall growth – reinforcing the true value of enhancing Star ratings.

While these numbers bode well for Medicare Advantage plans, 2023 Medicare Advantage and Part D Star Ratings showed a marked decline in overall ratings from 2022. This had a material impact on revenue growth and several payers are aiming to proactively address Stars ratings improvements in real-time.

Gaining optimal results from clinical data is critical for helping Medicare Advantage plans to boost their Star ratings.
Medicare Advantage plans also need to focus on ongoing quality improvements throughout the year – not just leading up to when CMS unveils its Star Ratings in the fall.

This requires an ongoing commitment to quality improvement, including the allocation of resources and investment in technology and analytic tools to support ongoing monitoring and measurement of quality metrics.

Thankfully, the IMAT Flexible Payer Solution allows health payers to do this, while also boosting revenue, enhancing member care and achieving compliance.

Medicare Advantage plans can improve overall HEDIS reporting capabilities and STAR ratings because our solution’s Validated Data Stream designation in the new NCQA Data Aggregator Validation (DAV) program.

The IMAT Payer Solution does this by ingesting the clinical data obtained from Provider EMRs on a real-time basis and prepares the data for validation by NCQA, so that it can be used as standard supplemental data in HEDIS reporting.

Ultimately, this helps Medicare Advantage plans to take a patient-centered approach to enhancing overall member care, which can enhance overall Star ratings.

Are you ready to boost care outcomes and enhance your overall Star Ratings? Please contact us to schedule a 20-minute demo of the IMAT Flexible Payer Solution with our experts who have a combined 40 years of experience in healthcare informatics.