Plan Preview 2: What to Know & What to Do Right Now

The annual Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Ratings Plan Preview period has begun! With this year’s combination of new measures, weighting changes, new cut point calculation methodology and immense amount of looming change, the annual fourth quarter Stars fire drill is shaping up to be the hottest one ever!

To help plans focus their attention, here are three noteworthy things we learned during Plan Preview 2 and three actions to take.

3 Things to Know

1. Tukey caused cut point changes to be more volatile than normal. Though the very nature of cut point calculations makes them relatively unpredictable, and while this model will result in less volatility in the future, this year’s implementation of the Tukey outlier deletion model made cut points significantly more volatile than normal. Thankfully, once we cope with this initial year’s impact, CMS’ use of the Tukey model should mean less volatility in the future. In the meantime, more than 50% of the individual cut points increased this year, with 20 individual cut points jumping by greater than 10%.
   
2. At a national level, healthcare quality improved. Because measure-level ratings are assigned based on relative performance nationally, and with so many measures included in the Star Ratings program, it can be complicated to discern the degree to which quality has improved or declined. But the Improvement measures are designed to measure improvement and they show plans are improving healthcare quality. With Improvement measures comprising 10% of a plan’s Overall Star Rating, continuous quality improvement across all measures is key to a plan’s success.
   
3. For some plans, the Reward Factor will be the deciding factor that unlocks Quality Bonus Payments. The minimum raw rating for which a plan could earn a Reward Factor is 3.70. This will mean that the Reward Factor alone will tip some plans over the 4-Star threshold. While admittedly this will be a glorious gift for some plans, it heightens the impact of CMS’ implementation of the Health Equity Index next year.

3 Things to Do Right Now

1. Jumpstart innovation. After years of relative stability and COVID Extreme and Uncontrollable Circumstance (EUC) relief, this is the perfect time for a jumpstart. Use these next few months to embrace a fresh, new approach to the new and different work needed for Stars success. Consider replacing traditional health plan governance, often fraught with endless meetings, informational report-outs and never-ending deck prep, with action-oriented, rapid-fire projects. Give at least one person permission to decline meetings to focus on the deep work needed to future-proof Stars success. Make sure every person in every department understands how their daily duties impact Star Ratings and establish both their priorities and accountability to ensure success.
   
   
2. Accelerate action. Get busy working with members and doctors to schedule appointments to close HEDIS gaps and break through the barriers preventing members from getting the care and drugs they need. Update in-year Stars goals and expand analytics and the high-touch member support needed for success. As problems are surfaced during this work, articulate the problems to the Stars team so they can be solved at scale. Identify obsolete and outdated investments and tactics and repurpose the time and money to other, more needed work.
   
   
3. Add brilliance to the basics. Help departments who indirectly impact Stars think differently about the impact of their work on Stars. From Appeals measures to Disenrollment, the teams that make product, benefit, formulary and medical management decisions often don’t realize their impact on the Administrative and CAHPS experiences. Expand the education and awareness of the Health Equity Index, new Health Outcomes Survey (HOS) measures and expanded focus on the voice of the patient into all departments to ensure the right members are getting the right care at the right time in the right setting.

Pro Tip: If any one of your contracts received an Overall, Part C Summary, or Part D Summary rating under 3 Stars, sound the alarm to leadership. CMS will not approve applications for new contracts or service area expansions for the legal entity holding any contract with any Overall or Summary rating under 3 Stars for two or more years. And if this is your second year of an Overall, Part C Summary or Part D Summary rating, make every day, and every member interaction count, to prevent your Measurement Year 2023 performance from triggering the Low Performing Icon and its painful consequences.

Whether your plan earned 4 stars or not, this is an important time to be intentional. By identifying and solving problems, the right investments into specific solutions and innovations will be fast follows that produce desired Star Ratings results.

We know how hard it is to succeed in Star Ratings in this era of change, when decisions must be made with no safety net and when both the risks and stakes of decisions are high. If you need help, call us. We love helping plans achieve and sustain strong ratings. Email me at Melissa.Smith@healthmine.com for more information.