Following last week’s graphic on Medicare Advantage (MA) star ratings, this week we highlight how different types of MA plans perform along certain patient outcomes metrics. The HD1 indicator, for example, calculates the number of beneficiaries that receive certain physical preventive care including cancer screenings and annual flu shots. From 2019 through 2025, provider-sponsored health plans (PSHPs) consistently earned a higher HD1 score than their competitors. The average HD1 rating for a PSHP in 2025 is 3.83, which compares favorably to the 3.63 average for BUCCAH plans (referring to six of the largest traditional payers), and a 3.24 average for all other plans. This difference in average HD1 scores is particularly remarkable for the annual flu shot indicator, labeled C03. In 2025, PSHPs had an average rating of 3.99 contrasting with a 2.94 average for BUCCAH plans and a 3.13 average for all other plans. The strong performance of PSHPs may be explained by their incentives for clinical and management sides to collaborate, easing patients’ journey throughout the care continuum. In addition to these positive primary care results, PSHP beneficiaries report a higher satisfaction with their plans than their counterparts. The average HD3 measure, or a member experience score that quantifies members’ access to and quality of care, is higher for PSHPs than their competitors. Once again, PSHPs are likely reaping the benefits of vertically integrating their payer and provider arms. They are better positioned to manage and coordinate the care of their beneficiaries, especially for primary care, giving PSHPs a strong competitive edge.
