Rule changes and fallout from the recent Clover Health lawsuit verdict are reshaping how CMS calculates Star Ratings, and Medicare Advantage (MA) organizations that do not pivot fast enough could face severe consequences.
A half-point drop in Star Ratings for an MA plan covering 480,000 members can cost an estimated $260+ million in Quality Bonus Payment (QBP) reductions alone, according to our analysis at AArete. That doesn’t include the subsequent loss of rebates, leaving plans with precious few resources to invest in ancillary benefits and improve the member experience.
