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The Medicare Advantage Star Ratings never stop changing, making it imperative for health plans to stay one step ahead of new annual rules and regulations. This year will be no exception: CMS has already released 2024-2025 proposed rules for MA plans to consider.
CMS is significantly upping the ante on performance for MA plans, and the changes to the Star Ratings rubric is expected to have dramatic impacts on quality bonus payments (QBPs).
“We are anticipating a $25 billion reduction in QBPs over the next decade if these cost-saving proposals become the office rule,” cautioned Nathaniel Lucena, Senior Consultant at Rex Wallace Consulting. “Plans that don’t want to get caught short need to take the time right now to understand the proposed changes and implement proactive strategies to reduce their risk of lower bonus payments.”
On Wednesday, January 25, Lucena will be joining Kempton Presley, Chief Analytics Officer, and Glenn Wirick, Chief Commercial Officer, both of AdhereHealth, in a webinar to provide a rundown of the major upcoming changes. Panelists will offer actionable steps for MA plans to improve performance and rise to the challenges of the evolving Star Ratings system.
“Now is not the time to get complacent about quality, heath equity and outcomes for members,” added Kempton Presley. “Plans need to start executing on these goals right now so they’re not caught short when the proposed changes begin to take effect.”
What’s in store for MA plans in 2024-2025?
CMS’s great expectations for Medicare Advantage plans include an increased focus on health equity, closer attention to the safe and appropriate use of medications, and a push for continuous improvement—even for high-performing 4- and 5-Star plans.
Major changes include:
- A shift from 4.0 Stars to 5 Stars for the Quality Improvement (QI) “hold harmless” provision, which will put pressure on 4.0- and 4.5-Star plans to keep improving on individual measures
- The new Health Equity Index (HEI), designed to reduce health disparities and improve outcomes for members with identified social risk factors (SRFs), plus replace the existing Reward Factor
- Changes to the weighting of CAHPS and Admin/Ops measures of Member Experience, as well as new and returning HEDIS measures that re-balance the math of Stars
- New and revised medication adherence and medication prescribing measures to manage chronic conditions
How should health plans respond to these proposed changes?
“There’s no time to lose for health plans that want to successfully navigate this increasingly complex environment,” said Lucena. “Plans will need to get a handle on their baseline performance, implement technologies and strategies to monitor and motivate improvement, and focus on factors like medication adherence and the social determinants of health (SDOH), which can boost overall performance.”
To learn more about the 2024 Star Ratings proposed changes and how health plans can develop a successful action plan in response, join us for our webinar, “2024 MA Rule Changes Are Coming: No Time to Relax” on January 25 at 1 PM CT. Click here to register.
