How to achieve a 5-star rating?

Based on the most recent CMS Medicare star ratings (see our blog), one of two courses of action seems best:

  • Emulate the successful policies, procedures and strategies employed by Kaiser Foundation Health Plans, or
  • Launch a new Medicare Advantage plan in Wisconsin

Kaiser had almost half of the 5-star Medicare Advantage plans in 2012 with five of the 12 highest rated plans. Kaiser followed up its dominance in 2012 by placing seven of its health plans amongst the fifteen highest rated Medicare plans in 2013. The only other Kaiser plan that received a rating from CMS just missed the list, receiving 4.5 stars.

Only one other organization has two health plans amongst the 5-star rated plans (Medical Associates).

Everyone can’t follow Kaiser’s model, so that leaves the other alternative, move to Wisconsin. Whether Wisconsin residents are just more generous in their evaluations of health plans or the level of competition has elevated the quality of care and member services, is not clear. What is clear, however, is that four of the fifteen 5-star plans hail from Wisonsin and one of last year’s 5-star plans that slipped from the list was also from the Badger state (Security Health Plan only received 4.5 stars in 2013).

It must be contagious because neighboring Minnesota placed one of its plans amongst the top 15 plans. Only California (both Kaiser) and Washington (Kaiser and Group Health Cooperative) managed to get two MA plans in the top 15. Side note: Hawaii has one MA-PD (again, Kaiser) and one PDP plan (Hawaii Medical Service Association) amongst the top rated plans. Humana’s only 5-star plan is located in Wisconsin, along with Dean Health, Medical Associates and Gundersen Lutheran.

The old adage “location, location, location” may also apply to health plan ratings – at least when it comes to Medicare Advantage companies in Wisconsin.

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