CMS Recalculates Star Ratings — Again
CMS is recalculating some 2026 Medicare Advantage Star Ratings after a court ruled it improperly calculated Clover Health's rating, a decision that could boost payments for a small number of insurers.
The New Game Plan for Star Ratings Must Start with Member Incentives
Medicare Advantage plans can more effectively position themselves for success under an evolving measurement system. Here are three strategic actions health plan leaders should prioritize to enhance 2026 bids to secure stronger Star Rating performance.
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The Healthcare Payments Industry Has a Perception Problem
Healthcare payments are no longer about transactions. It’s about controlling the revenue cycle. And increasingly, that control is not sitting with ISOs.
What the Medicare Quality Rating Change Means for Healthcare Companies — and Patient Health
SMS is reevaluating its Star Ratings. Not only do health plans stand to benefit from the new calculations — all healthcare companies and millions of patients will reap the rewards.
Traditional Member Engagement is Broken. Daily Care Motivation is the Only Way to Improve Outcomes
It’s time to hold ourselves to a higher standard. Our industry needs to reimagine what can be accomplished in member engagement by more effectively incorporating behavioral science principles and personalization into our solutions, just as leaders in other industries have done.
Why Insurers Beat CMS In the MA Star Ratings Battle
CMS recently announced that it is recalculating Medicare Advantage Star Ratings. It comes after two lawsuits on the issue.
Star Ratings and Member Experience: Two Sides of the Same Coin
The challenge? Maintaining high Star Ratings or improving upon existing ratings gets increasingly difficult over time.
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Top 7 Modern AI-Powered EAP Providers for Global Workforces in 2026
Discover the top AI-powered EAP providers for 2026. Compare platforms like Kyan Health and Spring Health on triage speed, global reach, and clinical quality to transform workforce wellbeing.
Does Chronic Disease Management in Medicare Advantage Need a ‘Retail’ Makeover?
Adopting consumer strategies from leading retailers can give MA plans an edge in an increasingly competitive market filled with new entities while improving quality, reducing cost, and improving member loyalty.
Papa Launches Programs To Address Health-Related Social Needs, Improve Star Ratings
Companion care company Papa has created two programs for health plans: one that addresses social drivers of health and one that aims to improve health plans' star ratings.
Leveraging Personalized Digital Engagement to Elevate Medicare Advantage Star Ratings
With the Centers for Medicare & Medicaid Services (CMS) releasing annual changes that impact all facets of the MA Star Ratings program, health systems and providers need to stay ahead of these changes and navigate them effectively by leveraging technology that can guide and optimize the complete patient journey.
Healthcare Consumers and Leaders Are Disserved by Subjective and Perception-based Rankings
Instead of leaning on the arbitrary and subjective nature of prominent, perceived prestige-focused industry rankings, health systems must shift to a data-driven and mathematically sound approach to determining and benchmarking quality.
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New Webinar: The Payer AI Readiness Gap: Why Better Data Will Define the Next Era of Health Plan Performance
We'll explore why the next era of payer performance will depend on building a trusted data foundation that connects people, providers, and relationships across the enterprise.
Medicare Advantage Plans Need to ‘Win’ on Consumer Experience in 2023
With the elevation of member experience measures in Star Ratings, CMS is signaling a broader transformation in the role payers can and should play in the care delivery system.
Star ratings for Medicare Advantage, Part D see sharp drop for 2023, CMS shows
There are 260 MA plans with Part D coverage that received four stars or more for 2023, a share of about 51%. This is a steep decline from 2022, when there were 322 plans with four stars or more, accounting for about 68% of plans.
California sues nation’s largest nursing home operator for ‘cutting corners’ in patient care
The state of California is suing Brookdale Senior Living for alleged patient safety violations at 10 nursing homes in the state and for providing false data to boost its CMS star rating. Brookdale denies both claims.