Every year, the US drops billions of dollars into the Medicare Advantage (MA) quality bonus program, which rewards health plans based on their performance on a five-star rating system.

Sounds straightforward, right? Reward the best, nudge the rest.

“The demonstration rewards high performers more than low performers, creating an incentive for all performers to improve,” then-administrator Donald Berwick said in a press release in 2010, when the Centers for Medicare and Medicaid Services (CMS) launched the program following passage of the Affordable Care Act.

But fast forward to 2024: KFF predicted last month that most of this year’s bonus payments will go to plans from insurance giants like UnitedHealthcare, which is projected to get about $3.4 billion, amounting to 30% of the total bonus payment spend. Some experts, including Berwick, aren’t convinced these star ratings truly separate the good from the bad, and a study from 2021 found there’s insufficient evidence to prove these hefty bonuses improve care for the 32.8 million people enrolled in MA.

“The difference between a one-star rating and a five-star rating is very narrow and maybe not clinically meaningful,” Laura Skopec, senior research associate at think tank the Urban Institute, told Healthcare Brew.

Keep reading here.—CC

Diabetes advocates have officially joined the fight against pharmacy benefit managers (PBMs).

In September, advocacy groups the Diabetes Leadership Council (DLC) and the Diabetes Patient Advocacy Coalition issued a joint statement supporting a lawsuit from the Federal Trade Commission (FTC), which claimed in a press release that the three largest PBMs in the US “have abused their economic power by rigging pharmaceutical supply chain competition in their favor, forcing patients to pay more for life-saving medication.”

Insulin access. The biggest issue for advocates is the rising cost of insulin.

“This case underscores the urgent need for greater transparency and accountability within the pharmaceutical supply chain…The current system fails many patients,” the advocacy groups’ statement read.

Keep reading here.—CM

UnitedHealth Group has had a tough year, but it’s still hanging on.

Executives shared in the company’s October 15 earnings call that an increase in customers for UnitedHealthcare and its subsidiary Optum has raised revenue nearly $8.5 billion in Q3 to total $100.8 billion year over year. The company’s adjusted net earnings outlook is $27.50 to $27.75 per share, which is within November 2023’s projections of $27.50 to $28.00 a share.

But the group’s 2025 forecast of up to $30 a share fell below Wall Street estimates of $31.18 a share, Reuters reported. It’s a “more conservatively than is typical” outlook, UnitedHealth Group CEO Andrew Witty said during the call.

Here’s why.

Change Healthcare. The system still hasn’t gotten back all the business it had before the Change Healthcare cyberattack that paralyzed the US healthcare system in late February, Roger Connor, CEO of UnitedHealth’s data and analytics company Optum Insight, said.

Keep reading here.—CC

Real jobs, shared through real communities. CollabWORK brings opportunities directly to Healthcare Brew readers—no mass postings, no clutter, just roles worth seeing. Click here to view the full job board.