What's Happening?
New research from the National Committee for Quality Assurance (NCQA) indicates that Medicare Advantage (MA) plans with NCQA Accreditation consistently achieve higher CMS Star Ratings compared to non-accredited plans. The report, 'The Accreditation Advantage,'
analyzed overall CMS Star Ratings performance, 13 HEDIS® measures, and 7 CAHPS® measures. For Measurement Year 2024 (CMS Star Ratings 2026), 66% of Accredited MA plans achieved 4 or more Stars, versus 52% of non-Accredited plans. Accredited plans also scored an average of four percentage points higher on 13 HEDIS measures and showed better performance in meeting 4-Star cut points for eight measures, compared to just one for non-Accredited plans. This suggests that NCQA Accreditation is associated with more reliable and repeatable quality improvement capabilities within MA organizations. The study highlights that high-performing MA plans prioritize a culture of quality, use accreditation as a strategic roadmap, invest heavily in data acquisition and analysis, focus on whole-person care, build strong care delivery partnerships, and invest in community programs addressing social needs beyond clinical care.
Why It's Important?
The findings from NCQA's research have significant implications for the U.S. healthcare system, particularly for Medicare beneficiaries and MA plans. With over half of all eligible Medicare beneficiaries enrolled in MA plans, the quality of these plans directly impacts a large segment of the elderly population. Higher Star Ratings translate to better quality bonus payments for plans and can influence beneficiary enrollment decisions. The study modeled that if non-Accredited plans performed at the same level as Accredited plans, it could lead to 1.5 million additional care gap closures per year, avert 1,712–2,068 lifetime cancer deaths, and save an estimated $1 billion in Medicare medical costs over five years. This underscores the financial and health outcome benefits of structured quality improvement frameworks like NCQA Accreditation, promoting better health outcomes and more efficient use of healthcare resources across the nation.
What's Next?
The NCQA report encourages MA plans to consider accreditation as a strategic tool for enhancing performance and improving member outcomes. Plans currently without accreditation may evaluate the benefits of pursuing it to improve their CMS Star Ratings, potentially leading to increased enrollment and financial incentives. The emphasis on data-driven quality improvement, whole-person care, and community investment by high-performing accredited plans suggests a future direction for MA plans aiming to excel. Stakeholders, including policymakers, healthcare providers, and beneficiaries, may increasingly look to accreditation status as an indicator of plan quality. The findings could also influence regulatory discussions around quality metrics and accountability within the Medicare Advantage program, potentially leading to greater emphasis on comprehensive quality frameworks.
Beyond the Headlines
Beyond the immediate impact on Star Ratings and financial incentives, this research highlights a broader shift in healthcare towards a more holistic and data-informed approach to quality. The success of accredited plans stems from a commitment to a 'culture of quality' that permeates the entire organization, rather than being confined to a single department. This involves leveraging diverse data streams—claims, clinical, provider, pharmacy, and member experience—to create actionable intelligence. Furthermore, the focus on 'whole-person care' and addressing social determinants of health through community partnerships signifies a recognition that health outcomes are influenced by factors beyond traditional clinical settings. This integrated approach could drive long-term improvements in population health, reduce health disparities, and foster a more resilient and responsive healthcare system in the U.S.
