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The Reward Factor as an Essential Stars Ingredient




The success of a Medicare Advantage Organization’s (MAO) revenue model is highly dependent on its performance within the CMS Stars program. It is well known that a health plan’s Star rating impacts core aspects of the business including:

  1. The ability to earn a financial bonus: CMS is expected to pay out at least $10B in 2022
  2. The opportunity for 5 Star plans to enroll members on a year-round basis
  3. Elevated benchmarks during the bidding process for plans

Much has been made about the changes to the measures and weighting used to calculate Stars scores in 2023. In particular, plans were focused on the elevation of the CAHPS (Consumer Assessment of Healthcare Providers & Systems) to a 4x weighting relative to more “traditional” measures (i.e., HEDIS, HOS). As we look further into 2023 MAO Stars performance, there is a lesser-discussed but very high impact implication of CAHPS score challenges in 2023 and beyond: the “Reward Factor.”

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