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Improvement Bonuses

Average Star Rating Improvement Bonus

This annual opportunity measures how much you moved the needle from last year’s results. Even if you didn’t meet the 3.75 minimum requirement needed to earn the Average Star Rating Bonus, you can earn a bonus for improved performance when you increase your 2024 Average Star Rating from your 2023 Average Star Rating by at least 1.00 Star Rating.

You’ll receive whichever payment is greater — either the Average Star Rating or the Average Star Rating Improvement.

Payment structure for the Average Star Rating Improvement Bonus

MA-PCPi Average Star Rating increase Payment amount
At least 1.00 $50 per member per year (PMPY)

Example calculation for the Average Star Rating Improvement Bonus

2024 Star Rating ID Measure Measure performance percentage Quality rating MA-PCPi weight MA-PCPi weighted quality rating
C01 Breast Cancer Screening (BCS-E) 72% 4 1 4
C02 Colorectal Cancer Screening (COL-E) 84% 5 1 5
C09 Eye Exam For Patients with Diabetes (EED) 77% 4 1 4
C10 Glycemic Status Assessment for Patients With Diabetes (GSD) 72% 3 3 9
D08 Medication Adherence for Diabetes Medications (MAD) 89% 4 3 12
D09 Medication Adherence for Hypertension (RAS Antagonists) (MAH) 86% 3 3 9
D10 Medication Adherence for Cholesterol (MAC) 89% 4 3 12
D12 Statin Use in Persons with Diabetes (SUPD) 90% 5 1 5
C16 Statin Therapy for Patients with Cardiovascular Disease (SPC) 88% 4 1 4
N/A Getting needed care 90% 3 2 6
N/A Care coordination 88% 3 2 6
  Total 21 76
In this example, the Average Star Rating for the 2024 program year would be 3.62.

How to read the example

  • The measure performance column shows the percentage of your patients who meet the numerator criteria for each measure (the patient experience measures are an exception). The percentage determines the measure’s quality rating.
  • Each quality rating is multiplied by its MA-PCPi weight to determine the weighted quality rating
  • The sum of the weighted quality rating is 76. By dividing that total by the total sum of weights (21), the practice's Average Star Rating is 3.62.
  • The provider had a previous year Average Star Rating of 2.61
  • The difference between the current Average Star Rating and the previous Average Star Rating is 1.01
  • In this example, the practice would earn an improvement bonus of $50 PMPY

Annual Care Visit Improvement Bonus

Your practice can earn an Annual Care Visit Improvement Bonus when you increase your 2024 ACV completion percentage compared to your 2023 ACV completion percentage.

You’ll receive whichever payment is greater — either increasing your 2024 ACV completion percentage compared to your 2023 ACV completion percentage by 10 percentage points or more, or reaching a completion percentage of at least 90%.

Annual Care Visit (ACV) improvement threshold Payment for Annual Care Visit (ACV) improvement (per completed ACV for a MA-PCPi Customer as noted in the final reporting)
Improvement of 10—19.9 percentage points $100
Improvement of 20 percentage points or greater $150
Completion of 90% or greater $100