The 2023 release of the Medicare Star Ratings is just around the corner. In fact, the First Plan Preview of the Medicare Star Ratings has historically been released the first Friday in August. That means plans could see their 2023 Star Ratings as early as August 5.
The purpose of the First Plan Preview is for health plans to review all the measure level rates recorded by CMS and report final corrections, concerns or issues with the specific results prior to finalization of the Star Rating calculations. The Second Plan Preview in September will include actual Star Ratings of each measure and will give plans the opportunity to address concerns over rating calculations to CMS prior to final public reporting of Star Ratings in early October.
While it may seem like you have a lengthy timeline to craft your responses, don’t let these dates sneak up on you. There are steps Medicare Advantage plans can take today to identify and address any issues before the 2023 Star Ratings are finalized.
Begin Reviewing Your Internal Data
Plans should know most of these rates from their own internal monitoring and plan reporting, such as through Healthcare Effectiveness Data and Information Set (HEDIS) scores. However, plans need to carefully review every rate and respond to CMS within the specified time frame if discrepancies are discovered.
All concerns over the validity of a result should be contested as part of the First Plan Preview. It is important that plans do not wait for the Second Plan Preview when you realize the actual impact of a measure result on overall ratings.
Don’t Forget About the CAHPS Report
Typically, at the same time of the First Plan Preview, compliance officers will receive a CAHPS report. This will be the first opportunity to see the case-mix adjusted CAHPS rates along with the actual Star Rating ascribed to each measure.
Remember, unlike the other measures, CAHPS Star Ratings are not based on reaching a specific cut point but are based on the statistical difference from the mean (national average) and assessment of measure reliability.
Your CAHPS report should be reviewed alongside your internal data and the First Plan Preview to accurately identify discrepancies as early as possible.
Healthmine has Medicare Star Ratings subject matter experts that can help health plans review rates, craft any responses on discrepancies to CMS, and address quality improvement initiatives in Q3 and Q4 to have a positive impact on the 2024 Medicare Star Ratings. Contact Cynthia Pawley-Martin for strategic insights to ensure Star Ratings success.
Cynthia Pawley-Martin has a wealth of expertise from her long-tenured career as a healthcare quality improvement professional. She has consulted with dozens of Medicare Advantage plans on their Star Ratings programs and comes with a solid record of success leading and supporting quality programs across healthcare delivery systems, including health plans and large physician practices.
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