Leveraging operational excellence: Enhancing Medicare Star Ratings through effective adaptation
With significant changes coming to the Medicare Star Ratings, Medicare Advantage organizations (MAOs) need to adapt to maintain or recover their current tiers.
As health plans integrate the latest Medicare Advantage Star Ratings, they should proactively consider how to adjust processes to be best prepared.
Healthcare stakeholders must thoroughly evaluate CMS’s 2025 Proposed Rule, including its impacts and integration into the operations of Medicare Advantage plans.
This paper explores potential operational implications and strategic approaches to adapt to the significant changes in the Medicare Star Rating system. The healthcare industry is experiencing rapid evolution, characterized by regulatory changes and heightened competitiveness. We cover a range of potential ideas that MAOs can use to respond to the changes in the Star Rating system, by reassessing and modifying their operational practices to counter the potential negative impact on their financial stability. The paper is organized as follows:
- Background: Evolution of Medicare Advantage Star Rating System
- Case study: Preventive services (Part C)
- Deep dive: The appointment-based model (Part D)
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Leveraging operational excellence: Enhancing Medicare Star Ratings through effective adaptation
Given the impending changes to the Medicare Advantage Star Ratings, organizations should proactively act to preserve or improve their current ratings.