CMS Released Star Ratings Program Changes: It's About Member Engagement & Satisfaction

Read the latest on proposed Medicare Advantage changes for 2025.

With recent changes to the Star Ratings program announced by the Centers for Medicare & Medicare Services (CMS) on April 6th, now more than ever, Medicare Advantage (MA) plans must reevaluate planned strategies while keeping in mind the stipulations on data collection for 2021 Star Ratings. There is limited opportunity for plans to impact their 2021 Star Rating, as CMS will be utilizing 2019 HEDIS® and CAHPS scores.

Additionally, COVID-19 will change the way members engage in care and rate their health plan. Proactive engagement and the ability to over-communicate with your members to get the right care when it’s appropriate will be key to successful member outcomes, plan rating outcomes, and financial performance tied to your population.

2022 Star Ratings—It's Imperative to Act Now

CMS is anticipating big changes in the Star level cut-points. First, CMS is removing the guardrails to enable true measurement of performance without penalizing plans due to COVID-19. This will cause the entire bell curve to shift, and there will be uncertainty in the final ratings.

CMS will also expand the hold harmless protection—previously applied to high performing plans on the improvement measures—to all health plans, in order to limit the negative impact of year-over-year measurement performance declines.

This means the result will be calculated with Health Plan Improvement and Drug Plan Improvement (5x Weighted Measures), as well as without the HPI and DPI 5x measure; then the higher rating will be applied.

The winning plans will be those that show improvement in these measures:

• Medication Adherence for Chronic Conditions: This should be a top priority. Getting needed medications and refill reminders will be key to helping Part D triple weighted measures. Additionally, Statin Use in Persons with Diabetes (SUPD) is a 3x weighted measure for 2021 and 2022 Ratings. The four Medication Adherence measures will be 43% of the Part D score and a large component of the overall Drug Plan Improvement measure.
• Digital Mock-CAHPS Survey/NPS: This will help you keep a pulse on member satisfaction, during a time when people are going to need more support.
• Preventive Services: The window for preventive services will be diminished due to non-critical care delays during COVID-19. Plans will need to engage their members in a timely and strategic manner to maximize performance during the 2020 calendar year. The ability to reach your members digitally and timely will be key in maximizing your incentive and reward strategy.
• Chronic Conditions: Members with chronic conditions may prolong their appointments in fear of contracting COVID-19. Therefore, plans may need to increase usage of test kits, in-home services, and mobile units, and also need the ability to reach appropriate segments of the population.
• Blood Pressure: Controlling blood pressure is returning to 2022 Star Ratings. Make sure you can collect your members’ self-reported BP readings and highlight the uncontrolled members and engage them further.

5 Steps You Can Take Right Now

#1: Strategically modeling opportunities to maximize plan performance in areas that need attention due to the changes, and directly engaging health plan members in the following areas:

• Medication refill reminders
• Mock-CAHPS surveys
• Net Promoter Score (NPS)
• Health action reminders (HEDIS®)
• Incentives and rewards fulfillment and distribution
• Chronic condition program support and supplemental benefit support

#2: Supplement and/or enhancing plan’s member engagement and incentive & rewards strategy.

#3: Providing mock-CAHPS functionality and information to address the satisfaction of the member at the plan and local provider level, in a digital and timely manner so they can create actionable, pro-active improvement.

#4: Capturing a real-time Net Promoter Score and comments from plan members and a digital feedback loop to share through an end-user interface in real-time.

#5: Quickly setting up a plan’s ability to collect member’s self-reported BP reading, as well as finding and informing uncontrolled members to further engage and incentivize them to report.

Final Thoughts

In this uncertain time, keep in mind the importance of proactively identifying and engaging members during and following the pandemic to help them better navigate their healthcare and offer up a little peace of mind.