Published on .
As we prepare to turn the page on 2023, it can help to reflect on what’s occurred in the Medicare Advantage space in order to prepare for what’s to come in 2024.
This past year, MA plans were reeling from the potential evolution of quality measures ushered in by the 2023 CMS proposed changes; among them, potential qualification expansions to the MTM program, adjustments to the QI Hold Harmless provision, and new Part D measures that will challenge plans to address polypharmacy in specific high-risk medications.
Though the 2024 Star Ratings presented a somewhat startling dip in overall scores due to rising cut points (thanks, in part, to the Tukey outlier deletion) health equity continues as a major focus for future Stars improvements (and to earn rewards). As such, the Health Equity Index (HEI) was finalized and is due to begin in measurement years 2024 and 2025—requiring plans to strategize how to address socially vulnerable members within their population.
One underlying foundation, a repeated theme within our top 5 blogs, is the need to improve adherence to medications and other recommended treatments by taking action to help members identify and resolve social determinants of health (SDOH) barriers. As the industry continues to evolve in 2024, we’re eager to see additional outcomes from CMS that will undoubtedly help guide plans toward strategies for future Star Ratings improvements.
Here are our top 5 most popular blogs of 2023:
Addressing health disparities to improve health outcomes across the member population is a key area of focus for CMS Star Ratings, as evidenced by the new Health Equity Index (HEI) and proposed Social Needs Screening and Intervention (SNS-E) HEDIS measure. As a result, MA plans must understand key factors of the HEI, such as qualifications and calculation of rewards, especially since the index will be replacing the current reward factor beginning in 2024… just around the corner.
The ability to identify and resolve SDOH barriers, especially in members with specific social risk factors (SRFs), will be critical for the HEI, as well as the proposed SNS-E. This measure will require plans to measure the percentage of members being screened for specific SDOH factors, as well as the percentage of those who receive an appropriate intervention for uncovered SDOH barriers.
Check out this blog for detailed information about both the HEI and SNS-E measure, as well as actions plans can take to improve health equity across the entire member population.
2. What MA Plans Need to Know About Proposed 2026 Part D Star Ratings Measures
The opioid epidemic continues to hit the United States hard, even within the Medicare population. As a result, CMS has proposed three Part D measures addressing patient safety with opioids, benzodiazepines, and polypharmacy as related to these high-risk medications.
The COB, Poly-ACH and Poly-CNS measures will require MA plans to identify members at risk of drug interactions or side effects within this class of medications. The key to addressing this challenge lies with a provider-first approach and year-round data monitoring to identify members in need of intervention.
To check out additional details that will help MA plans prepare for finalization of the new Part D measures, click here to keep reading.
3. Using the Quintuple Aim to Prep for CMS Star Ratings QI Hold Harmless Provision Changes
Perhaps the most impactful proposed change from CMS in 2023 is the adjustment to the QI Hold Harmless provision—currently exempting 4.0+ Star plans from certain penalties if they fall short on the 5x-weighted Quality Improvement measures. The proposed change will shift the concept of a “high-performing” plan from 4.0 up to 5.0 Stars on QI measures, meaning that only plans scoring 5 Stars will reach the “hold harmless” threshold.
As the proposed change from CMS will have far-reaching effects on plans relying on being “held harmless” as a means to protect their Star Rating, preparations for the change require plans to focus heavily on their performance on the critical quality objectives. One strategy is to leverage the five points of the Quintuple Aim of Healthcare as a guide toward future improvements.
To learn more about actions MA plans can take to boost quality improvement within their Stars performance, click here to check out this blog.
Though 2024 proposed changes from CMS will move the MTM measure to display, allowing MA plans more time to prepare for the sweeping 2023 proposed changes to the measure, it’s still important to have a strategy in place. The 2023 proposed changes expand access for an increased number of members into the MTM program, which will present a financial challenge for plans in terms of scaling up their MTM efforts to accommodate the enrollment influx.
One strategy for plans is to improve their ability to identify and reconcile drug therapy problem (DTP) gaps as a means to reduce unnecessary medical costs related to poor medication adherence. Improved efficiency in this gap resolution can help plans prevent medical spending, a savings that can also enable them fund, in whole or in part, the anticipated enrollment increase.
Check out our blog to read more!
5. Features of a Robust, Data-Driven Technology Solution to Resolve SDOH Barriers for High-Risk Members
When it comes to resolving SDOH barriers to improve access and adherence to treatments and medications, the foundation of success is the right technology platform. By finding a partner that provides a Software-as-a-Service option to empower clinician outreach, MA plans can gain a better understanding of the SDOH barriers faced by their member population, especially those at the highest-risk of nonadherence to medications and treatment protocols.
What are the leading capabilities of a strong data-driven platform? Check out our blog for key features of a robust platform that drive adherence improvements, better health equity and higher Star Ratings.
Here’s to your Star Ratings success in 2024! We wish you and yours a happy and healthy holiday season, as we continue to provide you with valuable and actionable blog content in the New Year.
And if you’re not already subscribed, you can stay up to date with industry happenings and never miss a post when you subscribe to our blog feed!
