Discover how Elevance Health’s Medicare Advantage contracts experienced a significant boost in star ratings for 2024, following a revision by the Centers for Medicare & Medicaid Services (CMS). Despite initial setbacks, Elevance projects nearly half of its Medicare Advantage members will now be enrolled in plans rated four stars or higher, with an estimated financial benefit of $190 million for payment year 2025. This improvement comes amid legal challenges against HHS for alleged methodology changes impacting star ratings calculations. Through legal action and ongoing performance enhancements, Elevance aims to uphold its commitment to delivering high-quality healthcare services to Medicare beneficiaries while navigating the complexities of the Medicare Advantage landscape.
Elevance Health’s Medicare Advantage star ratings witnessed a remarkable turnaround for the 2024 assessment period, thanks to a reassessment by CMS. This reversal comes after an initial decline in star ratings, prompting legal action against the Department of Health and Human Services (HHS). Central to the dispute is the contentious “Tukey” method, introduced by CMS in 2020, and its subsequent implementation in the 2024 ratings. Amidst regulatory challenges, Elevance presses forward, aiming to not only secure financial benefits but also to enhance trust and confidence among beneficiaries. This introduction sets the stage for a deeper exploration of Elevance’s journey toward improving Medicare Advantage star ratings.
The filing, dated March 4, reveals that Elevance anticipates approximately 49% of its Medicare Advantage members will now be enrolled in plans rated at four stars or above for the 2024 cycle. This adjustment translates into substantial financial gains for the company, with an estimated benefit of around $190 million slated for payment year 2025.
Notably, the initial ratings released in October painted a less optimistic picture for Elevance, with the percentage of members enrolled in contracts rated at four stars or higher plummeting from 64% in 2023 to a mere 34% for the upcoming 2024 period. Particularly concerning were the declines in three of the company’s largest MA contracts, which saw their ratings drop from 4.5 or four stars to 3.5 stars.
Explaining the rationale behind the revision, a spokesperson from CMS stated in a March 5 statement to Becker that the agency offers an administrative review process for Medicare Advantage organizations to contest payment determinations linked to quality bonuses. This process allows organizations like Elevance to request a review of their ratings for Quality Bonus Program determinations and rebate retention allowances, potentially leading to updates in star ratings based on the findings of these reviews.
However, Elevance’s journey to improved star ratings hasn’t been without its challenges. In December, the company took legal action against the Department of Health and Human Services (HHS), alleging unlawful and arbitrary changes in the methodology used to calculate Medicare Advantage and Part D star ratings.
At the heart of the lawsuit lies the contentious “Tukey” method, introduced by CMS in a 2020 final rule and implemented in the 2024 star ratings. This method aimed to mitigate the impact of extreme outliers on measure scores, thereby ensuring that outliers wouldn’t disproportionately influence all MA contracts and make it more difficult for plans to achieve high star ratings.
One of the key grievances articulated by Elevance in its lawsuit is the timing of the Tukey method’s reintroduction in the 2023 rule. Despite being omitted in the 2022 final star ratings rule, CMS reinstated the change in the subsequent rule, citing its inadvertent removal. Elevance contends that CMS failed to account for the annual 5% limit on scoring changes when reintroducing the Tukey change in 2023, which should have been considered before implementing the adjustment.
The legal dispute underscores the complexities inherent in the evaluation and scoring of Medicare Advantage plans, particularly concerning the methodologies employed by CMS to ensure accuracy and fairness in rating assessments. Elevance’s case raises broader questions about transparency, consistency, and regulatory oversight within the Medicare Advantage landscape, highlighting the need for clearer guidelines and more rigorous oversight mechanisms to safeguard the interests of both beneficiaries and providers.
As Elevance navigates the intricacies of its legal battle with HHS, the revised star ratings offer a glimmer of hope for the company’s Medicare Advantage offerings. With improved ratings come not only financial benefits but also enhanced trust and confidence among beneficiaries, reinforcing Elevance’s commitment to delivering high-quality healthcare services to its members.
As Elevance Health navigates legal challenges and regulatory complexities in the Medicare Advantage landscape, the upward trajectory of its star ratings underscores a commitment to excellence and member satisfaction. Despite initial setbacks, the revised ratings herald a new era of opportunity, positioning Elevance as a leader in delivering high-quality healthcare services to Medicare beneficiaries. Through strategic initiatives and ongoing performance enhancements, Elevance aims to cement its reputation for reliability and quality, ensuring beneficiaries receive the care they deserve. As the healthcare industry continues to evolve, Elevance’s resilience and determination serve as a beacon of hope, signaling a brighter future for Medicare Advantage enrollees nationwide.