For Medicare Advantage Plans, the Plan Preview cycle for Star Ratings is either considered the most exciting and busy time of the year or the most dreaded and energy-draining. The anticipation of reviewing the data submitted to the Centers for Medicare & Medicaid Services (CMS) for accuracy, the potential challenges that may arise from errors and a first view of cut points are enough to keep even the longest tenured Star leader up for nights on end. However, Plan Preview should be viewed as a process and built into our annual workplan and approached with strong fully vetted methods of review.
What to Expect with Plan Preview
The first Plan Preview allows plans to review the data submitted to CMS. Plans should begin by reviewing all measure rates and reporting any issues within CMS’ specified timeframe for submission of errors or challenges. The second plan preview, which comes in early September, includes the actual Star Ratings, along with cut points for each measure. CMS will allow plans to address any outstanding issues with Star Rating calculations, prior to the official 2024 Star Ratings becoming public in October.
What to Do Prior to Plan Preview 1
CMS has already released numerous Health Plan Management System (HPMS) memos with data that will be part of the 2024 Star Ratings. Over the past few weeks, HPMS has alerted plans of the availability of measure data related to Members Choosing to Leave the Plan, Call Center Monitoring Performance, HOS Cohort 23 Results, MTM CMR Star Rating Measure Exclusion Reports, and CAHPS survey results. Plans should have already started their review of this data to ensure accuracy and identification of any challenges that may be appropriate for submission.
What to Do When Plan Preview 1 is Released
The data CMS releases during Plan Preview should not come as a surprise to plans. Rates for each measure should already be part of internal reporting and monitoring processes. Once the data from CMS is available, plans should review each rate closely against their internal data to ensure accuracy. Any challenges a plan has with their data must be submitted to CMS during the first Plan Preview and should not wait until the second Plan Preview to understand the impact on final ratings.
It is go-time for plans, and we are here to help. Reach out for questions about appropriately reviewing your data. Healthmine is here to help. Our team of experts can help you validate your data and submit your response to CMS if you find discrepancies. Time is of the essence to ensure your Star Ratings are 100% accurate. Reach out to me at John.Willis@Healthmine.com to get started evaluating your performance and correcting any CMS errors.