Star Ratings Impact of Medicare Advantage Members Use of Veterans Affairs Facilities

Improving Medicare Advantage Star Ratings by Documenting Veterans Care

As 2019 is officially here, Medicare Advantage plans are continuing to look for opportunities to positively impact their Star Ratings. The Star Ratings are important for Medicare Advantage plans for a variety of reasons including Quality Bonus Payments and marketing rules. Many of the Star Ratings are impacted by HEDIS measurements.

For years, most Medicare Advantage plans have had a hidden challenge in attempting to meet these HEDIS measurements – care that their members receive through the Department of Veterans Affairs. To put the challenge in context:

• 22% of Medicare Advantage members are Veterans
• 5% of Medicare Advantage members receive some care each year at VA facilities  (Source:  GAO)

By law, the VA does not bill either Medicare or Medicare Advantage plan, so documentation of this care, provided to Medicare Advantage plan members, is not communicated to Medicare Advantage plans. For instance, C:07 Adult BMI Assessment measures the percentage of members “who had their Body Mass Index calculated from their height and weight and recorded in their medical record.” Per CMS, to receive a 5 Star rating for this measure, 98% of plan members must have this completed.

With approximately 5% of plan members receiving care at the VA, it may be impossible for plans to meet this higher standard without the ability to document the BMI calculations that VA providers complete as part of their Annual Wellness Exam.

BMI Assessment is just one of many Star Rating measures which can be positively impacted by documenting the care that Medicare Advantage members receive at the VA. At BeneLynk, we help Medicare Advantage plans improve their Star Ratings by identifying Veterans and documenting the “invisible” care that these members receive through the VA. This starts with identifying the members of a plan that are Veterans, and those that use the VA for any of their healthcare needs.

The following chart shows the measurements and the rate of encounters that meet the requirements of the associated metric for an analysis we conducted of actual charts retrieved from VA facilities

By retrieving documentation of all the care that Medicare Advantage members receive at the VA, plans can significantly impact their Star Ratings. Want to hear more? Drop us a line at