New NCQA Research: Accredited Medicare Advantage Plans Perform Better on CMS Star Ratings

Healthcare organizations are under increasing pressure to improve outcomes, close care gaps and demonstrate value in a rapidly changing environment. With more than half of all eligible Medicare beneficiaries enrolled in Medicare Advantage (MA) plans and high financial stakes through Star Ratings and quality bonus payments, leaders need to understand: What organizational capabilities are consistently associated with better performance?

NCQA’s new report, The Accreditation Advantage, explores that question by examining the relationship between NCQA Accreditation and CMS Star Ratings performance.

We analyzed overall CMS Star Ratings performance for Accredited and non-Accredited MA plans and compared results across 13 HEDIS^® measures and 7 CAHPS^® measures included in the Star Ratings.

What We Found

Accredited MA plans outperformed non-Accredited plans across all 13 HEDIS measures studied and were more likely to achieve higher CMS Star Ratings. They also showed less variation in performance, suggesting that Health Plan Accreditation may help organizations build more reliable and repeatable quality improvement capabilities.

Here are some key findings for Measurement Year 2024 (CMS Star Ratings 2026):

• Higher star ratings. 66% of Accredited MA plans achieved 4+ Stars versus 52% of non-Accredited plans.
• Stronger HEDIS results. Accredited plans scored an average of four percentage points higher than non-Accredited plans on 13 HEDIS measures.
• Better cut point performance. The Accredited plan average exceeded the 4-Star cut point for eight measures versus just one measure for non-Accredited plans.
• Modestly stronger CAHPS results. Accredited plans trended higher on several member experience measures.

Why It Matters

The implications extend far beyond ratings and rankings. NCQA modeled what could happen if non-Accredited plans performed at the same level as Accredited plans across the analyzed measures. The results point to meaningful opportunities in terms of care gaps closed, Medicare medical costs averted and lives saved.

If non-Accredited plans performed at Accredited plan rates, it could mean:

• 1.5M additional care gap closures per year.
• 1,712–2,068 lifetime cancer deaths averted among the population screened.
• An estimated $1B in Medicare medical costs averted over five years.

In a healthcare environment facing increasing financial pressure and growing demand for accountability, these numbers underscore the potential value of a structured and repeatable quality improvement framework.

View the clinical outcomes and modeled population health impact for all 13 HEDIS measures on our website here.

How Accredited MA Plans Impact Population Health and Outcomes

Strong HEDIS and Star Ratings performance is rarely the result of a single program or intervention. It requires a long-term investment in data, infrastructure and clinical programs to improve the health of members and communities. NCQA interviewed quality and clinical leaders from high-performing Accredited MA plans and several common themes emerged.

Create a culture of quality. The most successful MA plans view quality as an organizational responsibility, not the work of a single department. Leaders prioritize quality from the top down and create shared accountability for outcomes.

Use Accreditation as a roadmap for improvement. Many plans describe Accreditation as a strategic improvement framework and a structured way to identify gaps, strengthen accountability and drive organizational performance.

Double down on data acquisition and analysis. High-performing MA plans view data as a strategic asset. They combine multiple streams of information—claims, clinical, provider, pharmacy and member experience data—to create actionable intelligence that supports quality improvement and population health management.

Focus on whole-person care. Successful MA plans go beyond traditional claims-based analysis to develop a comprehensive understanding of each member’s health status, risks and needs. The focus shifts from simply identifying care gaps to understanding the barriers that created those gaps and deploying targeted interventions that make it easier for members to receive the care they need.

Build strong care delivery partnerships. The strongest plans do not simply encourage clinicians to improve quality performance. They actively equip them to succeed—from providing actionable data to support value-based contracting to investing in equipment and infrastructure that improve access to care.

Invest in communities and address needs beyond clinical care. Many drivers of population health occur outside the walls of traditional healthcare. As a result, high-performing MA plans are investing in community partnerships and programs that address access, health literacy, social needs and member engagement.

Read success stories from NCQA-Accredited MA plans on our website here.

Get the Report

Visit ncqa.org/accreditation-advantage to explore the data, learn about our analytic methods and find out how NCQA-Accredited Medicare Advantage plans are improving population health and outcomes.

A Note About Our Methods

Results are based on NCQA analysis of Accreditation status, HEDIS performance and publicly reported CMS Star Ratings data for Medicare Advantage plans.¹ Estimates are associational, not causal. Real-world impact calculation inputs are modeled estimates based on findings from research studies related to the HEDIS measures in the CMS Star Ratings. All studies are referenced on our methods page.

¹ https://www.cms.gov/medicare/health-drug-plans/part-c-d-performance-data

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).