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A review published in the Journal of the American Society of Nephrology examines how Medicare Advantage Star quality measures address care for people with kidney disease. The issue is relevant to managed care because the Centers for Medicare & Medicaid Services uses Star ratings to evaluate Medicare Advantage Part C plans, and those ratings are tied to plan bonuses and enrollment.
The review comes as more patients with end-stage renal disease are enrolled in Medicare Advantage. Since the 21st Century Cures Act, the share of these patients in Medicare Advantage has increased from less than 30% in 2021 to more than 50% in 2024. The authors note that, along with the rising prevalence of chronic kidney disease, this shift gives Star measures a larger role in assessing kidney care.
To evaluate the measures, the American Society of Nephrology Quality Committee convened a working group led by Dustin Le and colleagues. Using a modified version of the American College of Physicians Measure Review Criteria, the group assessed 25 of the 45 Star measures tied to clinical outcomes and excluded nonclinical measures such as customer service. The group rated 13 measures as high validity, including measures related to diabetes, hypertension, and care transitions, and 12 as medium validity across preventive and other chronic care areas.
The committee found that the measures were generally supported by appropriateness and clinical evidence, but that the evidence was more limited for patients with end-stage renal disease. It also identified 10 measures that may exclude these patients. According to the review, only one measure directly captured guideline-directed kidney care: albuminuria screening in patients with diabetes. The authors reported that no Star measures addressed other guideline-directed recommendations, including chronic kidney disease screening and risk stratification, nephrology referral, kidney-specific pharmacotherapy, chronic kidney disease education, or preemptive transplant referral.
The committee concluded that the 2026 Part C and D Star measures do not fully align with guideline-directed kidney care. The authors said closer alignment could support improved outcomes, lower costs, and higher-value care for people living with kidney disease.
