Ingredients for Success in Value-based Payment: The Case of Medicare Advantage “Stars” Quality Ratings

Who succeeds when large payers, such as Medicare Advantage (MA), pay for value? A recently published study in Medical Care, “The Concentration of Physician Services Across Insurers and the Effects on Quality,” suggests that health plans that contract with physicians who are more exposed to the quality measures established under a value arrangement are more likely to succeed.¹ In particular, health plans with contracted physicians who focus their Medicare practice on Medicare Advantage patients performed better on the CMS Star quality measures than physicians whose practice included a smaller than average share of patients enrolled in private Medicare Advantage plans. In short, it pays for health plans to contract with physicians who are going “all in” on value-based...