While ACOs don’t receive CMS Star Ratings directly, many are evaluated on the same quality measures that drive Medicare Advantage (MA) Star Ratings. These ratings serve as a powerful benchmark that incentivizes value-based care and drives quality improvement across ACO networks.

What Are CMS Star Ratings?

Star Ratings are CMS’s public quality measurement system used to evaluate the performance of Medicare Advantage (MA) and Part D plans. They combine data on clinical outcomes, patient experience, and operational performance to assign plans a 1- to 5-star rating.

Higher ratings lead to increased consumer confidence and financial incentives, including higher per-beneficiary payments and opportunities for shared savings.

How Do Star Ratings Impact ACOs?

For ACOs that work with Medicare Advantage plans, Star Ratings play an important role in guiding performance and partnership decisions.

• Financial Incentives: Strong performance on Star Rating measures can contribute to higher reimbursement rates and pay-for-performance rewards.

• Quality Improvement Focus: ACOs often target the same outcome-based measures, such as chronic disease management and preventive care, that drive Star Ratings.

• Network Standards: MA plans prefer to partner with high-performing organizations to ensure their provider networks meet CMS’s quality benchmarks.

In this way, ACOs align their care delivery and reporting processes with Star Rating priorities, reinforcing their commitment to value-based care.

How Are Star Ratings Determined?

CMS calculates Star Ratings using multiple data sources, including:

• Clinical Quality Measures: Tools like HEDIS provide insights into the quality of care delivered.

• Patient Experience Surveys: Feedback from CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys.

• Operational and Outcome Metrics: Data on medication adherence, hospital readmissions, and other key performance indicators.

Outcome-based measures carry greater weight, reflecting CMS’s focus on tangible, patient-centered results.

Quick Summary

• ACOs & Star Ratings: ACOs don’t receive Star Ratings directly, but many align with MA Star Rating measures and are evaluated on overlapping quality domains.

• Purpose & Impact: These benchmarks drive care improvement and influence financial incentives, partnerships, and network standards.

• Determination: Ratings blend clinical outcomes, patient experience, and operational performance metrics.

How Medisolv Helps

Medisolv empowers ACOs and their partners to improve performance on the quality measures that underpin CMS Star Ratings. Our solutions help organizations:

• Centralize and validate data from multiple EHRs

• Automate performance tracking across CMS and MA programs

• Deliver actionable insights to boost quality measure outcomes

Focus on delivering exceptional patient care while Medisolv handles the complexity behind the data.

Want to Dive Deeper? Explore more Medisolv resources:

• 2025 Star Ratings Calculation

• How Does CMS Calculate the Hospital Star Rating?
• Hospital Star Rating and Leapfrog Safety Grade Improvement Services