Quality: Stars, HEDIS & Experience
Learn how CMS measures plan quality and why Stars ratings directly impact Belong's revenue and competitive positioning.
The Star Rating System
CMS rates MA plans on a 1-5 Star scale annually based on ~40 measures across HEDIS (clinical quality), CAHPS (member experience), and HOS (health outcomes). A 4-Star rating unlocks a quality bonus payment (~5% revenue uplift).
Stars Revenue Impact Simulator
~$450,000 annual quality bonus
Smaller plan — Stars bonus still meaningful for supplemental benefit investment.
Key HEDIS Measures for Belong
Diabetes Care
HbA1c control, eye exam, kidney monitoring
Medication Adherence
Statins, RAS antagonists, diabetes meds
Preventive Screenings
Breast cancer, colorectal cancer, osteoporosis
Transitions of Care
Follow-up after inpatient discharge
Controlling Blood Pressure
BP <140/90 for hypertensive members
Annual Flu Vaccine
Flu shot administered in measurement year
Knowledge Check
Question 1 of 3
A Medicare Advantage plan with 4+ Stars receives:
💡 Reflection: How would Belong's care management platform prioritize outreach differently for a member with 3 open HEDIS gaps vs. one with no gaps?