Quality Metrics & Performance
Expert articles and analysis related to quality metrics & performance.
AI Summary — Last 24 Hours
The Medicare Advantage quality regime is under fresh pressure as Elevance sued CMS over its post-Clover Health star ratings recalculation, alleging inconsistent methodology cost the insurer $115 million—an immediate warning for MA plans that Star Ratings disputes are becoming high-stakes revenue litigation, not just compliance issues (Healthcare Dive). At the same time, KFF estimates MA quality bonus payments will exceed $13 billion in 2026 despite fewer enrollees in bonus-eligible plans, intensifying scrutiny on whether the Star Ratings program is rewarding true quality improvement or inflating Medicare spending ([KFF](https://news.google.com/rss/articles/CBMixAFBVV95cUxNSzhmdENYSmU0Y1Fzd0l2WHU5RHNUdDM5WGpPUjVlR1BsQXVBSUZfN3l6SmNMWDRXQVhIZlNVMkw1VlNNa2d3cEh2WHFXOHoyQ1hOOGEySkF1SjJ6Q0NOWU1uaEhNaDRVNUJGYjdVazFkUy00SHRWLU5aNHhWTU1uVTFfa3Q2c0JDT2RlMzJ0Sm4xWEVOMDhFMnkyZUpv
Related Articles
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 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 ...
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Spooner Health receives 5 stars from CMS Overall Hospital Quality Star Rating
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STAT+: Elevance sues government over $115 million tied to Medicare Advantage star ratings
The health insurer says CMS didn't calculate its star ratings appropriately.
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