Quality Metrics
Expert articles and analysis related to quality metrics.
AI Summary — Last 30 Days
CMS is moving MSSP and physician payment policy toward a more digitally measured, primary-care-centered VBC architecture: the CY 2026 PFS/MSSP proposals would materially alter ACO benchmarks, shared-savings forecasts, and participation economics while putting ACOs on a 2027–2030 path toward FHIR-based digital quality measurement—forcing earlier investment in data infrastructure, EHR interoperability, and quality analytics (Wakely MSSP analysis, Wakely digital quality roadmap). In parallel, CMS is signaling a broader quality-program reset—phasing down MIPS, expanding ACO participation pathways, and strengthening primary care incentives—while MA Star Ratings remain under legal and financial pressure, with Clover-related litigation and a projected $13B+ 2026 MA Quality Bonus Program raising payer concerns about rating stability, bonus predictability, and the credibility of quality-linked payment.
Related Articles
Heart of Health Policy | ACC Urges Changes as Ambulatory Specialty Model Approaches
Heart of Health Policy | ACC Urges Changes as Ambulatory Specialty Model Approaches American College of Cardiology
Elevance sues CMS after Medicare Advantage stars recalculation
Regulators recalculated plans’ quality scores last month after losing a lawsuit to Clover Health. But they used a different methodology for Clover than its peers, causing Elevance to lose out on $115 ...
Medicare Will Spend More Than $13 Billion on the Medicare Advantage Quality Bonus Program in 2026
The Medicare program will spend at least $13 billion on the Medicare Advantage quality bonus program in 2026, as 68% of Medicare Advantage enrollees are in a plan that qualifies for higher payments un...
Post-Clover and 2027 QBP Re-Calculation: What Could Be Next for MA Stars?
Overwhelmed ACOs: House aims to simplify quality reporting requirements
Overwhelmed ACOs: House aims to simplify quality reporting requirements Medical Economics
Overwhelmed ACOs: House aims to simplify quality reporting requirements
Medicare Advantage bonuses will exceed $13B this year, KFF finds
Medicare is spending more on quality bonuses despite fewer enrollees in eligible plans, the health policy research group said — a concerning trend putting more stress on Medicare’s coffers that could ...
Rethinking Coding and Documentation in a Value-Based Care Environment
How to Embed Person-Centered Outcomes Into Your Quality Strategy
How to Embed Person-Centered Outcomes Into Your Quality Strategy NCQA
new KFF analysis
From newsletter: Spending on Medicare Advantage Quality Bonus Program Will Total $13.4 billion in 2026 Federal Spending on the Medicare Advantage Quality Bonus Program Will Total $13.4 billion in 20...