Medicare Advantage 5-Star Reporting of Physician Organizations
Modeled on the 5-star rating system for health plans, IHA uses 13 clinical quality measures to award and publicly report Medicare Advantage (MA) star ratings at the physician organization (PO)-level in California. Many MA plans lack sufficient enrollment to accurately measure PO performance and target quality improvement efforts because of the fragmented nature of the state’s MA market. The IHA star rating system aggregates PO performance data across multiple MA plans to improve measurement reliability and validity and reduce reporting burdens for physician organizations.
Participating health plans and POs receive targeted performance information to guide improvements in patient care. In turn, improved PO performance can impact health plan eligibility for bonus payments of up to 5 percent from the federal Centers for Medicare & Medicaid Services. PO-level performance data also allow MA plans to identify and reward high-performing physician organizations. Additionally, IHA uses PO star ratings to report publicly on the quality of care for Medicare beneficiaries through a partnership with the California Office of the Patient Advocate and to recognize high-performing physician organizations earning 4.5- and 5-star ratings.