Star Ratings Plan Preview #2
It’s hard to believe, but it’s that time of year again. Yes, it’s football season—and it’s also the beginning of Star Ratings season.
The Centers for Medicare & Medicaid Services (CMS) annual Star Ratings plan preview periods have become as much an annual ritual for Medicare Advantage (MA) plans as the Advance Notice and Call Letter, and plans throughout the nation are feverishly working to understand their 2016 Star Ratings so they can quickly determine what still needs to be done during the fourth quarter to close out 2015 strong.
Although there were few surprises in the 2016 Star Ratings measure specifications, there was much to be gleaned from the long-awaited removal of the remaining pre-determined 4-Star thresholds. As expected, almost as many 4-Star thresholds were decreased as were increased. The plan preview measure specifications show 4-Star cut points were tightened on 20 measures and relaxed for 13 measures. Measures where the 4-Star cut points were relaxed included those with significant patient lifestyle and perception impacts, such as medication adherence, diabetic blood sugar control, and several Consumer Assessment of Healthcare Providers and Systems (CAHPS®) measures. In contrast, measures with tightened cut points include many of the Healthcare Effectiveness Data and Information Set (HEDIS®) process measures, where plans and providers have a long history of focus and attention to gap closure. In contrast, 4-Star cut points were only relaxed for one administrative, or plan-controlled, measure, which demonstrates plans are “controlling the controllables” within the program. Again, no big surprises in these changes. But the absence of surprise does not mean it will be easy for plans to adapt to these changes.
So what can we take away from the plan preview?
- CMS continues to use the Star Ratings program to compel health plans to increase their strong focus on quality improvement in their service to beneficiaries.
- Plans must continue investing efforts in longer-term strategic relationships with members and providers to continue improving health outcomes, meeting beneficiary expectations, and performing well in the Star Ratings program.
- With the increasing competition in MA and full adoption of the bell curve within the Star Ratings program, the definition of success is likely to continue to rise. There is simply no such thing as “good enough” in Star Ratings.
With approximately five percent of MA plan revenues tied to Star Ratings performance through Quality Bonus Payments, an objective review of a plan’s Star Ratings infrastructure, strategy, and performance can be a wise investment.
Resources
Whether your plan missed the overall 4 Star Rating necessary to earn Quality Bonus Payments, or whether the new 4-Star cut points have introduced new risks of maintaining your overall 4 Star rating, we can help. Our team of experts understands the Star Ratings program and knows how to influence performance. Contact us to learn more >>
Join us on Friday, October 9, from 1-2 pm ET, as John Gorman, Founder & Executive Chairman at Gorman Health Group (GHG), examines the state of government healthcare programs and outlines proven tactics market leaders are implementing to cut costs, increase member satisfaction, and drive sustainable growth. Register Now >>