As the nation’s healthcare system adapts to the COVID-19 pandemic, CMS has announced changes to 2021 CMS Medicare Advantage Star Ratings to maximize quality improvement in this unique year. Given the substantial impact, we will be launching a multi-part series of information and resources to support Medicare Advantage Star Ratings success.

CMS’s latest update brings an expansion of the Patients Over Paperwork initiative, which reduces red tape and allows health plans to allocate more resources towards consumer care and outreach during COVID-19. Further, plan submission for HEDIS and CAHPS data is not required in 2020 for 2021 Star Ratings.

CMS will use 2019 measurement year data for HEDIS and 2018 measurement year data for CAHPS measures in 2021 CMS Star Ratings, and 2020 HOS administration has been postponed to late summer pending further review. However, most Part D measures are still in effect, meaning that health plans must focus on these measures to move the needle on 2021 CMS Star Ratings. These Part D measures heavily emphasize medication adherence, and several of these measures are triple-weighted.

 

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Since Part D medication adherence is now the primary lever for improving 2021 CMS Star Ratings, health plans need to maximize the use of technology to both offer pharmacy resources and identify those at risk for non-adherence. For a full inventory of measure changes, please subscribe to our blog.

As you know, CMS has adjusted some guidelines on pharmacy refill authorizations to aid consumers with their adherence while social distancing guidelines and safer-at-home orders make pharmacy access more complicated.

  • Automatic refills language has been amended
  • Plans may allow maximum extended day supply fills if needed to prevent disruption in consumer access to medications.

To support medication adherence, health plans must directly connect their membership to the most appropriate pharmacy. Predictive analytics on consumer-specific adherence issues should be deployed with targeted engagement to overcome social determinants of health (SDOH) issues.

Next, we will elaborate more details on recommended pharmacy resources health plans should consider for Star Ratings improvement. Subscribe to our blog to get the full list of measure statuses and to get our latest resources as soon as they post.

Additional Resources

Webinar: Planning for 2020 Through Medication Adherence

Medication Adherence: The Lever to Improve Medicare Advantage Star Ratings (AJMC)