The Centers for Medicare & Medicaid Services (CMS) have released the 2021 Star Ratings for Medicare Advantage and Prescription Drug Plans (PDPs or Part D plans), and like most news happening this year, the headlines are unprecedented.

Key Highlights from the 2021 Medicare Advantage Star Ratings

Here’s what we know so far:

  • The 2021 enrollment weighted average Star Rating dropped from 4.16 to 4.06
  • The percentage of contracts at or above 4 Stars dropped from 52% (210 contracts) to 49% (194 contracts)
  • The percentage of members in contracts at or above 4 Stars dropped from 81% to 77%

Of the contracts earning ratings in both 2020 and 2021:

  • 65 contracts improved their overall rating, with 19 picking up the 4th Star
    • 7 of the 19 contracts are large Blues plans, who have been aggressively chasing the Nationals
      • 6 of the 7 Blues plans managed to drive improvement despite not owning their own PBM
  • 85 contracts saw their 2021 overall Star Rating drop, with 31 losing their 4th Star
    • Most of the Nationals saw 1 or more contracts drop under 4 Stars, as did 1 large Blues plan
    • Substantially, all of the Nationals saw a decrease in the number of members in 4+ Star rated plans

CMS also introduced the following measure weighting changes in the 2021 ratings:

  • CAHPS and administrative measures increased to 2x weights. The average rating of 3.31 across all CAHPS measures placed a drag on plan ratings. But the average rating of 4.26 across administrative measures counterbalanced the impact of CAHPS measures.
  • Statin Use in Persons with Diabetes (SUPD) increased to 3x weight. With a national average rating of 3.0, this measure hindered many plans’ performance.

What MA Plans Should Do Next

As plans now realize the sizable impact of increasing CAHPS measures to 2x weights in the 2021 ratings, it’s important to prepare for a doubling again beginning 1/1/2021 when these measures increase to 4x weights.

With this in mind, we expect to see significant changes in the traditional “4th quarter push” activities. As I tell plans every year, if you hit 4 Stars, now is not the time to be complacent. And if you didn’t hit the 4-Star mark, now is not the time to panic.

Here are a few tips to close out the 2022 ratings cycle strong:

Carefully analyze your “2022 Star Ratings math path,” accounting for the COVID-19 relief granted by CMS. Since CMS has already issued a final rule allowing plans to use the higher of their 2021 final rating or earned 2022 rating on non-CAHPS measures, there may be a subset of measures where no further effort is needed at this time.

Ensure your CAHPS efforts are precise and aligned with actual measure specifications, rather than being “feel good activities” or loosely focused on broader member experiences. CAHPS measures are not included in CMS COVID-19 relief, and we know that our members are struggling with many of the detailed nuances measured by M-CAHPS measures. Focus on getting relationally connected with your members, particularly if you have the luxury of relaxing efforts on other measures (per the previous tip).

Check on your members. Our MA members are struggling during this pandemic—with both accessing needed care safely and managing all aspects of their health. As the “next COVID wave” descends upon us, combined with shorter days and colder weather for many, the physical and mental health of our members will be increasingly fragile. Make sure your care managers and navigators are outreaching to as many members as possible to check-in, help them with/through their issues, and connect them with available resources. And for those with whom you cannot communicate using live personnel due to lack of staff or budget, begin deploying digital pulse surveys to understand their experiences and health status before the blackout period begins. Then you can use live personnel to follow up on those self-reported struggles with questions that will be on the spring survey.

Make sure everyone in your organization understands that:

  • Every member matters. In the past, reaching every member was costly, time consuming, and daunting. However, scalable, digital health tools can be quickly implemented to nudge the next best health actions for each member, perform experience and outcomes surveys, and complete HRAs. The data captured from these activities can then trigger ongoing, repeated engagement with members in ways that support your Stars improvement needs.
  • CAHPS and administrative measures will be 4x-weighted beginning January 1, 2021 (impacting the 2023 ratings). This will drive exponential ROI from all initiatives focused on the 2022 ratings since the spillover effect in well-designed efforts has a long tail.

Increase prioritization and multi-measure efforts directed towards Medication Adherence, the Controlling Blood Pressure measure, and the CDC-A1c Controlled measures. Many plans stumble due to pursuing adherence interventions separately from HEDIS® interventions without realizing their interrelatedness. And since many members are in 4 (and some in all 5) of these denominators, coordinated and persistently performed interventions drive higher return, particularly when simultaneously supporting CAHPS measure needs.

Last, but not least, make sure all internal technical calculations are up to date. Many plans wait until late in the year to update HEDIS® calculations. However, the NCQA’s measurement year (MY) 2020 technical specification updates issued this summer were, in their words, sweeping. As a result, it is vitally important to ensure that 4th quarter efforts are directed at the right members for each measure.

Final Thought

This article is just the tip of the iceberg when it comes to understanding the latest Star Ratings results, deciding what to do with your remaining time this year, prioritizing next year’s activities, and preparing for what’s to come. Fortunately, HealthMine is hosting a webinar on Tuesday, November 10th at 12:00 PM CT where I’ll be taking you through a deep dive on where we are now with Star Ratings and what’s on the horizon. Register now and add the webinar to your calendar—you won’t want to miss it!

From supporting scalable, efficient, digital member engagement to helping develop a roadmap for quality improvement, our experts have deep expertise and can provide the assistance you need to conquer your Star Ratings goals. For more information, email me at melissa.smith@healthmine.com.

Melissa Smith is Executive Vice President of Consulting & Professional Services at HealthMine. She brings 25+ years of experience in Star Ratings, strategy, sales, and marketing to our client partners, providing expert advisory services across all areas of quality improvement.

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