Medicare Star Rating

All Medicare advantage plans are invariably linked to quality ratings which make them eligible to receive bonus payments based on quality ratings provided by CMS. Initially established in the ACA,  bonus payments are made to plans that receive 4 or more stars, thus incentivising businesses to perform better on quality ratings. With the advent of digital, customers are more informed and demand higher quality of service from the insurers, making ratings an important component for plan sales.

Capgemini’s Medicare Star Rating is a consulting framework that helps payers improve CMS star ratings, by allowing insurance companies to identify areas of concern and make improvements to Medicare Advantage plans. Our analytics and reporting platform provides a view of customer feedback on Medicare Advantage plans and plan relevant actions to improve ratings. Furthermore, it allows companies to perform analysis on competitors’ Medicare Plan ratings vis-à-vis a company’s own MA plans based on certain parameters. As a result, companies can take targeted action in resolving customer issues.

Business Benefits:

  • Consulting Services – Identifies gaps within payer organization and helps in prioritization of areas to derive best results
  • CMS Data Analytics – A UI view of the star rating data for competitive analysis on various parameters that define the ratings. As a result, it reduces the complexity and improves cost efficiency in floating a new product in the market
  • Technology Solutions – Provides IT support to bridge the gaps
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