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The 2023 Star Ratings plan preview offers a valuable sneak peek into Medicare Advantage performance and gives health plans insights on where they should focus their efforts for the upcoming year.
In early September, CMS released the second plan preview for the 2023 Medicare Advantage Star Ratings, giving health plans a concrete look at how they performed in 2021, a period filled with uncertainty and rapid changes. Plans get two chances to review their data and preliminary Star Ratings before they are finalized in early October.
This year, it is more important than ever for plans (especially those that serve high-risk populations) to keep a close eye on their Star Ratings performance. The 2021 performance year was a transitional one: after providing significant relief to MA plans during the first year of the COVID-19 pandemic, CMS is now returning to more stringent guidelines to ensure continual quality improvement in the growing Medicare Advantage marketplace.
As a result, some plans that have recently enjoyed higher Star Ratings during the pandemic may be in for a surprise as cut points on heavily weighted adherence measures are increasing. In addition to the resumption of pre-pandemic standards, continued emphasis on Part D adherence means Medicare plans will need to implement new strategies to rapidly focus on this area.
With the fourth quarter of 2022 still in front of us, plans have an opportunity right now to implement “surge and jumpstart” programs to finish the 2022 performance year strong—while also getting a head start on improvements in adherence for 2023 in all unengaged members, including their highest-risk population, helping them conquer social determinants of health (SDOH) barriers to achieve adherence.
Adjusting the Goal Posts to Prioritize High-Quality Care
The Star Ratings criteria change frequently. CMS is constantly making changes to their expectations to emphasize quality of care for Medicare beneficiaries and high-priority areas, such as medication adherence and positive patient experiences.
During COVID-19, CMS took action to prevent plans from plummeting through the rankings while being overwhelmed by critically ill patients.
For example, disaster relief provisions for 2022 Star Ratings allowed plans to receive the “better of” their 2020 performance or 2019 performance for most measures, with the expectation that plans would struggle in their 2020 performance due to the pandemic.
Thanks to this and other decisions, approximately 70 percent of plans achieved 4 Stars or higher during COVID-19. “Pre-pandemic, that number was closer to 50 percent,” said Rex Wallace, a leading quality improvement consultant and guest speaker for AdhereHealth’s October 19 webinar, “2023 Star Ratings: Analysis of Notable Findings.”
These plans might be facing a harsh awakening regarding their 2023 Star Ratings, however, as the cut points continue to shift. While nearly half of the cut points got somewhat easier to reach for 2023, the opposite has happened in some specific areas, such as medication adherence. While some plans performed better in this area, others did not keep pace. Due to the competitive nature of Stars, plans who aren’t keeping up with their peers are seeing the results in their aggregate Star Rating. Overall, the fact that many plans have performed well on the triple-weighted medication adherence measures has driven the cut points up. This is a concern for plans struggling with these triple-weighted measures.
“This isn’t a product of CMS changing the rules,” Wallace pointed out. “CMS is not tinkering with the cut points or changing the formulas in these areas. This is a result of some plans performing better, which is raising the threshold for their peers. The curve is responding to the results, not the other way around.”
“That’s going to be a problem for plans that have been relying on CMS flexibilities to jump into higher Stars categories instead of focusing directly on improving their medication adherence activities,” he cautioned. “The market is outperforming what used to be the status quo, and plans will need to keep up with that trend to maintain their higher ratings in the future.”
Given the continued pressure to improve adherence, even the highest-performing plans will need to implement new strategies to engage higher-risk members and improve medication adherence-related Stars measures. In the past, broad-stroke outreach and single transactions may have sufficed, but plan/member relationships need to evolve through whole-person, targeted support tailored to each individual, especially those at greatest risk of falling away from the recommended treatment plan—often due to multiple SDOH challenges and other barriers to care.
Reflecting on the Past and Preparing for the Future
Aside from the chance to correct errors, the 2023 Star Ratings are now more or less in the books. Plans should take the next few months to course-correct for any missteps and create a proactive roadmap for improving their quality in the upcoming performance year.
This involves developing a deep understanding of how the Star Ratings guidelines will change in the upcoming year and carefully mapping 2023 Star Ratings results to these new rules.
Plans can use the final quarter of the 2022 performance year to focus on areas of opportunity, test out new initiatives and get one step ahead of any issues that might affect performance when the clock ticks over to performance year 2023.
“The Stars medication adherence measures require plans to start strong from day one and help their members maintain adherence for the long term, while addressing healthcare inequities,” explained Cyndi Alexander, Chief Adherence Officer of AdhereHealth. “Data-driven insights embedded in telepharmacy software workflows make this outreach much more personalized and effective, which is crucial for promoting engagement, especially in high-risk members facing SDOH concerns.”
She added, “If a plan needs 80 or 90 percent of members adherent to their chronic disease medications 80 percent of the time, they can’t afford to just start getting them on their medications halfway through the performance year. Plans should establish a regular cadence of outreach based on daily data updates. This helps engage higher-risk individuals by addressing needs based on their specific situation.”
“October through December is the perfect time to jumpstart any new changes to the plan to make an impact on the next Star Rating, for example during the last quarter of 2022 for the 2024 Stars,” Alexander advised. “Consider implementing medication optimization analytics tools and collaborating with a healthcare partner that offers digital pharmacy services. Data-driven organizations like AdhereHealth can help health plans rapidly scale their member engagement and adherence activities during the last quarter of 2022 to help members overcome SDOH concerns to drive improved adherence in the current plan year, and from the beginning of the next performance year into the future, so it’s ongoing.”
Ensuring Star Ratings Success in Performance Year 2023
The Star Ratings yearly plan preview data gives plans a crucial early look at their performance. Now more than ever, plans need to take a deep dive into their Star Ratings results and get as far ahead of next year’s requirements as possible. The finalized data is expected on October 6, in just a few weeks.
On October 19 at 2:00 EST / 11:00 PST, Medicare Advantage stakeholders can join Rex Wallace, Principal of Rex Wallace Consulting, Cyndi Alexander, AdhereHealth Chief Adherence Officer, and Kempton Presley, AdhereHealth Chief Analytics Officer, in our latest webinar, 2023 Star Ratings: Analysis of Notable Findings.
During this presentation, plans will be able to see how their results stack up to the rest of the industry, learn more about what to expect in 2024 Star Ratings and ask questions of our expert panel to prepare for success in the year ahead.
To reserve your spot for the first webinar in our three-part series, visit the AdhereHealth registration page.
