322K
Additional people screened
The Accreditation Advantage
How NCQA Health Plan Accreditation Supports Clinical Quality and CMS Star Ratings Performance
› EXECUTIVE SUMMARY
NCQA Accredited Medicare Advantage plans outperform non-Accredited plans.
NCQA Accredited Medicare Advantage (MA) plans outperform non-Accredited plans on clinical quality and achieve higher CMS Star Ratings, with a greater share of plans operating at 4- and 5-Star levels.
These findings are particularly relevant in a market defined by increasing financial pressure, regulatory scrutiny and competition for members. Star Ratings directly influence bonus payments, benefit design and market positioning, making quality performance a strategic priority.
NCQA Health Plan Accreditation provides a structured, repeatable framework that can help plans strengthen performance and improve their ability to compete.
What We Found
- Higher Star Ratings: Higher percentage of Accredited plans operate at 4- and 5-Star levels.
- Stronger HEDIS® performance: Accredited plans lead on core clinical quality measures across years.
- Better cut point performance: Accredited plans more often clear CMS thresholds tied to higher ratings.
- Modestly stronger CAHPS® results: Accredited plans trend higher on several member experience measures.
Why It Matters
- Performance drives revenue: Stronger results support bonus payments that plans can reinvest into enhanced benefits and services.
- Quality drives growth: High-performing plans are better positioned to compete for members.
- Accreditation supports repeatability: Accreditation helps plans build durable quality improvement capabilities.
AT-A-GLANCE
66%vs.52%
Accredited plans achieve 4-5 Stars 66% of the time,
vs. 52% for non-Accredited plans
vs. 52% for non-Accredited plans
Medicare Advantage lags other lines of business in plan accreditation.
Across Medicaid, Commercial and Exchange markets, NCQA Health Plan Accreditation has become the standard for demonstrating quality. In Medicare Advantage — the line of business with the highest financial stakes through Star Ratings and bonus payments — fewer than 4 in 10 plans are Accredited. This report examines what that gap costs.
WHY ACCREDITATION HAS GROWN
In Medicaid, Commercial and Exchange markets, plans have increasingly turned to Accreditation as a way to differentiate, demonstrate operational discipline and meet purchaser expectations. Medicare Advantage has historically had less external pressure to accredit.
WHAT CLOSING THE GAP COULD MEAN
652K
additional people receiving recommended care annually
Aggregated from real-world impact estimates across the three featured measures (Colorectal Screening, Blood Pressure Control, Glycemic Assessment). Replace with finalized methodology figures.
› KEY FINDING #1: STAR RATINGS
Accredited plans consistently achieve higher overall Star Ratings year over year.
Accreditation is associated with stronger outcomes and it provides the structure and discipline required to sustain quality improvement over time. NCQA has set quality standards for health plans for more than 35 years and our Health Plan Accreditation is widely recognized as a rigorous framework for quality improvement and operational excellence.
Accredited Plans More Often Score at 4-5 Stars
% of MA plans with an overall CMS Star Rating of 4 Stars or higher (MY 2022–2024)
AT-A-GLANCE
14%
More Accredited plans received an overall rating of 4-5 stars in MY 2024
› KEY FINDING #2: HEDIS PERFORMANCE
Accredited plans outperform non-Accredited plans across 12 HEDIS measures that are included in the Star Ratings formula.
The advantage observed among Accredited plans suggests that Accreditation is associated with the development of these capabilities in a systematic and repeatable way.
Accredited Plans Outperform Non-Accredited Plans Across 12 of 13 HEDIS Measures
Average performance rates (%), MY 2024
AT-A-GLANCE
+4PTS
Average performance advantage of accredited plans across the 13 HEDIS measures.
› KEY FINDING #3: CUT POINT PERFORMANCE
Accredited plans clear the 4-Star threshold more often—and the gap is widening.
CMS sets performance thresholds (cut points) that determine whether a plan earns 1 to 5 Stars on each measure. The 4-Star cut point is especially important because plans must earn a rating of 4 Stars or higher to qualify for bonus payments. Even small differences near the 4-Star cut point can swing rating outcomes—and bonus payment eligibility.
Accredited plans have widened their advantage over non-Accredited plans from +4 measures exceeding the 4-Star cut point in MY 2022 to +7 measures in MY 2024.
NUMBER OF MEASURES WHERE ACCREDITED PLANS EXCEED THE 4-STAR CUT POINT
MY 2022
7
Accredited
vs
3
Non-Accredited
+4
Measures
The gap between Accredited and non-Accredited plan performance.
MY 2023
6
Accredited
vs
1
Non-Accredited
+5
Measures
The gap widened by 1 measure from MY 2022 to MY 2023.
MY 2024
9
Accredited
vs
2
Non-Accredited
+7
Measures
Accredited plans demonstrated the strongest performance in MY 2024.
› KEY FINDING #4: CAHPS PERFORMANCE
Accredited plans perform better on CAHPS measures of patient experience.
Similar to the HEDIS measures, most CAHPS measures show that Accredited plans trend toward better performance, but with greater variability and smaller differences.
Accredited Plans Perform Better Than Non-Accredited Plans on Most CAHPS MeasuresPerformance gap in percentage points, MY 2024
| CAHPS Measure | Accredited Avg | Non-Accredited Avg | Performance Gap (percentage points) |
|---|---|---|---|
| Flu Vaccine | 69.23% | 65.75% | +3.48 |
| Health Plan Rating | 87.54% | 86.72% | +0.82 |
| Health Care Quality | 87.18% | 86.63% | +0.55 |
| Customer Service | 90.53% | 90.23% | +0.30 |
| Getting Care | 81.49% | 81.25% | +0.24 |
| Getting Appointments | 83.88% | 83.83% | +0.05 |
| Care Coordination | 87.24% | 87.28% | -0.04 |
Notes: 1. Gap = Accredited plan average minus non-Accredited plan average (percentage points). Positive values indicate Accredited plans score higher. 2. Analysis includes 661 unique plans in MY 2024.
CAHPS measures add aMEMBER EXPERIENCE LENSto plan performance
Accredited plans generallyTREND HIGHERon measures of access, quality and communication
Why this measure matters.
Colorectal Cancer Screening
Controlling High Blood Pressure
Glycemic Status Assessment for Patients with Diabetes
Colorectal Cancer Screening
- Colorectal cancer is the second leading cause of cancer-related death in the United States.
- Screening can identify precancerous polyps before cancer develops.
- Early detection drives much better survival outcomes.
REAL-WORLD IMPACT
If non-Accredited plans performed at the same level as Accredited plans, it could mean:
850–1,010
Lives saved
$360M–$460M
Costs saved
Success Stories
Colorectal Cancer Screening
Controlling High Blood Pressure
Glycemic Status Assessment for Patients with Diabetes
PLAN
Priority Health
SERVICE AREA
Michigan
MEDICARE MEMBERS
270K
IN MEDICARE MARKET SINCE
2005
MY 2024 STAR RATING FOR COLORECTAL CANCER SCREENING:
5 Stars
Closing Every Gap, One Member at a Time
Priority Health developed a “Next Best Action” process to guide member outreach. The approach identifies the next action required to close a care gap for each member. Outreach generally follows a stepped escalation model:
- Initial letter or email prompting a primary care visit and outlining needed services.
- More frequent outreach after six months if care has not been completed.
- A phone call from the care team to help schedule an appointment or address other barriers to care.
- Home screening kits mailed to members who still do not complete needed screening.
The program relies on a continuous flow of claims and chart review data to target members most in need of support. Priority Health’s leadership attributes improved colorectal screening performance to this structured, data-enabled, multi-channel approach.
› IMPLICATIONS
How these findings relate to the broader healthcare industry and what to do next.
These findings point to specific actions for plans and policymakers who want to close performance gaps, reduce financial risk and improve outcomes.
FOR MEDICARE ADVANTAGE PLANS
Accreditation and Star Ratings work together
Plans that pursue Accreditation are building the exact infrastructure that drives Star Ratings results. These investments compound and do not compete.
Focus on clinical quality as the primary driver of Star Ratings performance
Strong execution on HEDIS measures is a consistent and controllable lever for improving overall performance.
Prioritize performance at critical thresholds
Small improvements near CMS thresholds (cut points) can meaningfully influence Star Ratings outcomes, making targeted interventions particularly impactful.
Invest in repeatable quality improvement capabilities
Plans that embed structured processes for identifying care gaps, engaging providers and tracking performance are better positioned to sustain results over time.
FOR POLICYMAKERS & CMS STAKEHOLDERS
Accreditation aligns with value-based care priorities
Accreditation reinforces performance on measures directly tied to outcomes, supporting broader efforts to improve quality and accountability.
Performance gaps have real public health consequences
The difference between Accredited and non-Accredited plans translates into hundreds of thousands of missed screenings and thousands of preventable deaths per year.
Standardization of quality improvement practices promotes consistency
Accreditation provides a consistent framework, helping reduce variability in how plans approach quality improvement.
Independent validation strengthens plan oversight
Accreditation provides an evidence-based signal of a plan's ability to execute on quality measures over time.