For many, October signals the beginning of Fall with the weather turning cooler and the smell of pumpkin spice in the air. For Stars leaders at Medicare Advantage plans, it means the nerve-racking public release of their Star Ratings.

For the past several years, the Star Ratings program has been relatively stable. However, because of the COVID-19 Public Health Emergency (PHE), this year’s 2021 Star Ratings specifications were subjected to an unprecedented amount of change as CMS attempted to address the impacts of the PHE on Star Ratings.

CMS Changes to 2021 and 2022 Star Ratings

CMS adopted a series of changes to the 2021 and 2022 Star Ratings to accommodate the disruption in members engaging with their providers, as well as worries about data collection and impacts on performance posed by the PHE for COVID-19 such as:

• Eliminated the requirement to collect and submit Healthcare Effectiveness Data and Information Set (HEDIS) and Medicare CAHPS data otherwise collected in 2020, and replaces the 2021 Star Ratings measures calculated based on those HEDIS and CAHPS data collections with earlier values from the 2020 Star Ratings (which are not affected by the public health threats posed by COVID-19).

• Removed guardrails for the 2022 Star Ratings by delaying their application to the 2023 Star Ratings.

• Expanded the existing hold harmless provision for the Part C and D Improvement measures to include all contracts for the 2022 Star Ratings.

• Revised the definition of “new MA plan” so that, for purposes of 2022 Quality Bonus Payments (QBPs) based on 2021 Star Ratings only, “new MA plan” now refers to an MA contract offered by a parent organization that has not had another MA contract in the previous 4 years, in order to address how the 2021 Star Ratings will be based in part on data for the 2018 performance period.

• Revised the definition of the Extreme and Uncontrolled Circumstances policy (EUC) because the PHE for COVID-19 meets the Star Ratings criteria for an extreme and uncontrollable circumstance in nearly all states/territories (and service areas). Most contracts will be eligible for the extreme and uncontrollable circumstance adjustments to their 2022 Star Ratings as a result of the PHE.

One thing that did not change was the planned increase of the Access, Experience and Complaints measures from 1.5 weight to 2 as codified into rule previously. 

2021 Star Ratings Program Results

At an individual level, most plans fared well with the changes that CMS implemented. However, when looking at the program overall, there was a slightly downward shift to the 2021 Star Ratings:

• 49% of Medicare Advantage plans received a 4+ Star Rating (down from 52%).

• 77% of Medicare Advantage beneficiaries are enrolled in contracts that have 4+ Star Ratings (down from 81%).

• 31 plans lost their 4 Star vs. 19 plans that gained their 4 Star Rating.

• 6 plans slipped from 5 Stars to 4.5 Stars with the 2021 Star Ratings.

Where Do We Go from Here?

Going forward for the 2022 Star Ratings timeline, as always, it is important that plans stay focused between now and June of 2021. The EUC policy will allow for plans to use the “higher of” Star Rating for most measures in the 2022 Star Ratings.

Additionally, “Hold Harmless” will apply for the Part C and Part D Improvement measures for 2022. MA-PD plans will not want to miss out on these, or any additional changes, that may still come from CMS.

GHG has a long history of working with health plans to develop a data-driven Star Ratings strategy and to improve your organization’s Star Ratings. Contact us to learn more. 

Stars 101 Workshop

GHG’s Senior Directors of Stars, Cynthia Pawley-Martin and Jessica Assefa, are leading a Stars 101 Workshop at the Strategic Solution Network’s upcoming Medicare Star Ratings & Quality Assurance Summit on December 1-3, 2020.

Their workshop titled, “How to Build and Grow Your Stars Program to Integrate All Measures” will include an in-depth review of the technical Star Ratings framework and data sources, as well as a deep dive into the technical specifications for measures used in Star Ratings.

This event is FREE to all health plans and providers. If you haven’t already, click here to register today!