Unveiling industry insights

The Centers for Medicare & Medicaid Services (CMS) released the 2025 Star Ratings for the Medicare Advantage program in October 2024. CitiusTech’s latest report provides a comprehensive analysis of these Star Ratings, comparing them with the previous year's ratings. This report offers valuable insights into industry performance, aimed at business, consulting, and technology stakeholders involved in improving Medicare Advantage Star Ratings. The analysis helps stakeholders strategically position themselves and adjust their initiatives for better Star Ratings.

Key highlights:

• Detailed retrospective analysis of Star Ratings performance.
• Identification of focus areas for actionable planning.
• Insights into performance challenges and strategies for 2025 and beyond. Focus Areas for 2025-26

Medicare business evolution: The Medicare landscape is changing with stricter regulations impacting Star Ratings and quality bonus earnings. To stay competitive, benefit designs must be more sustainable and profitable. Smaller payers might seek vendor solutions to navigate these changes, and there could be more mergers in the industry.

Clinical measure changes: Adapting to new clinical measures is essential. Early adoption and validation of updated specifications are crucial. Strategies need to be in place for new measures expected in the coming years. Monitoring performance and quality through Health Equity Index parameters is important, and aligning Medicare and Medicaid strategies will be necessary as new quality rating systems are introduced.

Forecasting and goal setting: High-accuracy analytics are needed for projecting future performance thresholds. Goals should consider shifts in cut-points, performance trends, and regional constraints. Understanding the impact on quality improvement measures is key to avoiding penalties.

Partnerships and initiatives: Building partnerships with community organizations focused on health equity is vital. Adopting value-based care arrangements with specialized clinical partners can improve outcomes and experiences.