Are you among the many health insurers dissatisfied with your most recent Medicare Advantage (MA) quality score? Unfavorable evaluations of customer support centers were the leading reason many health insurers saw a downgrade in their quality scores. Many payers felt these assessments placed undue focus on call center performance, which is the basis of a lawsuit filed against the Centers for Medicare and Medicaid Services (CMS).
These legal issues have been ongoing for some time now and continue as many insurers navigate a frustrating downward trend in their MA quality scores. These lower quality scores have been partially attributed to the lapse of temporary COVID legislation and modifications to the methodology used to score calculations. The courts have even sided with insurers, ruling that these methodology changes were seemingly arbitrary.
Remedying the situation
In recent statements, CMS representatives agreed that metrics surrounding call centers should not be as impactful as they have been. In fact, CMS reported that it has already made adjustments to the star rating process that should benefit insurers. These changes will go into effect during the next assessment cycle, which takes place in 2026.
CMS has announced plans to reassess other aspects of its star rating process in a move to reflect health plan quality more accurately. This is welcome news to many health insurers, as star ratings can have a direct impact on the corporate bottom line. Most health insurance executives would also agree that top ratings drive new subscriber enrollments and sharpen corporate credibility when building or growing provider networks.
In more welcome news, top-rated insurers can also apply to change their benchmarks. Changing these critical metrics can help place health insurers in a different class of plans, giving them an added competitive edge over other plans in their market.
What can your health plan do to boost its 2026 star rating?
1. Personalize member engagement as much as possible. One option is to use interactive platforms that allow members to seamlessly explore plan features, ask questions, and receive one-on-one support whenever they need it.
2. Increase member access to care by offering a wider range of preventive services with a robust provider network and working to lower deductibles and co-payments.
3. Optimize analytics for independent tracking of quality metrics, which can be used to inform your plan’s quality improvement processes.
To learn more about what the latest quality trends mean for your health plan, read our blog post highlighting the 2024 health plan ratings by the National Committee for Quality Assurance (NCQA). We’ve also included tips on how payers can make modest changes to increase their ratings.