Medicare to adjust disputed Star Ratings measure: Bloomberg News

The Biden administration is planning to adjust the Medicare Star Ratings System to lower the impact of call center scores, which have been the subject of several lawsuits filed by managed care firms in recent months, Bloomberg News reported.

In September and October, UnitedHealthcare (NYSE:UNH) and Centene (NYSE:CNC) sued the Medicare administrator, the Centers for Medicare & Medicaid Services (CMS), for unfairly downgrading their 2025 Star Ratings based on the call center measure,

Under the Star Ratings system, Medicare Advantage and Part D plans with four or more stars can receive annual bonus payments. Several measures, including call center scores are used in rating calculations.

The call center scores are “going to have a smaller weighting on star ratings moving forward,” Deputy CMS Administrator Meena Seshamani said Wednesday at the Milken Institute’s 2024 Future of Health Summit.

Plans are underway to adjust how to arrive at call center scores, Seshamani noted, adding, “It just sometimes takes time for these things to work their way through because of, you know, constantly looking at the methodology.”

In addition to UnitedHealthcare (NYSE:UNH) and Centene (NYSE:CNC), leading managed care plans with operations in the MA market include Humana (NYSE:HUM), CVS Health (NYSE:CVS), Elevance Health (ELV), Cigna (CI), Alignment Healthcare (ALHC) and Clover Health (CLOV)