CMS: Nearly $11 Billion Paid to MA Organizations from Medicare Advantage Quality Bonus Payment Demo

Monday, March 14th, 2016
This post was written by Patricia Donovan

The CMS three-year Medicare Advantage (MA) Quality Bonus Payment (QBP) Demonstration paid Medicare Advantage organizations an estimated $10.96 billion under the QBP Demonstration, according to the final evaluation report of the demonstration.

The report indicated that across the QBP demonstration period (calendar year 2012 to 2014), average Star Ratings improved, more beneficiaries enrolled in higher rated plans, and more beneficiaries had access to higher rated plans.

The three-year MA QBP Demonstration, launched in 2012, extended quality bonus payments established in the Affordable Care Act of 2010 to additional plans based upon Star Ratings.

While there is no definitive way to attribute these changes (in whole or in part) to the QBP demonstration itself, CMS said, evaluation analyses do show that the demonstration did not stall or reverse trends—Star Rating and plan enrollment increases that began prior to the demonstration continued throughout the demonstration period—and, in fact, QBP demonstration payments appear associated with reductions in out-of-pocket costs for beneficiaries.

Here are more findings from the MA QBP Final Evaluation Report:

  • MA contract ratings continued a pre-demonstration trend of improved overall Star Ratings and increasing beneficiary enrollment for higher rated contracts.
  • Compared to other coverage types, MA contracts show similar trends in average enrollment-weighted scores for selected measures.
  • MA organizations reported that the demonstration encouraged a focus on quality improvement efforts.
  • Enrollment changes are weakly related to changes in Star Ratings and not appreciably different between the QBP demonstration period and previous years.
  • On average, plans receiving bonus payments during the QBP demonstration period had below-expected out-of-pocket costs relative to a linear trend from 2011 to 2015.
  • Contracts that did not offer Special Needs Plans (SNP) had higher Star Ratings compared to contracts that had a mix of SNP and non-SNPs or contracts that had only SNPs.

The full report can be accessed here.

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