Star Ratings: Preparing for 2016
With the Centers for Medicare & Medicaid Services (CMS) release last week of its annual Request for Comments on Enhancements to the Star Ratings program, we now have our first official glimpse into the potential changes which could be introduced in the 2018 Star Ratings.
Consistent with CMS’ recent about-face on the impact of socio-economic characteristics on a plan’s Star Ratings, CMS laid out two potential interim analytical methodologies which may be used to help account for the Star Ratings differences of low income subsidy (LIS)/dual eligible (DE)/disabled members. CMS indicated these interim analytical adjustments will be interim solutions only and could be used while CMS completes its broader work on a more effective quality structure and payment model which more effectively supports the unique needs of LIS/DE/disabled members. CMS has requested health plan feedback regarding both potential options as well as recommendations for any additional permutations and/or hybrid approaches based on the two options presented.
CMS is not planning to add any new 2017 measures, which is welcome news to health plans, to be certain. However, CMS announced a number of potential new 2018 measures, some of which will bring transparency to clinical areas new to the Medicare Advantage Star Ratings program. Some of the new areas which could be Star rated include asthma medication management (including dispensation of, and adherence to, asthma medications), statin therapy prescribing patterns, and hospitalizations for preventable conditions (which will assess the quality and coordination of ambulatory care). In sharp contrast to recent history, in which we have seen very few new clinical measures added as Star Ratings, the nature and scope of these new measures will put plans squarely back in the driver’s seat to initiate new types of clinical quality improvement work with their providers.
The proposed retirement of the High Risk Medication (HRM) measure (which had an average national 2016 rating of 4.1) to the Display page and the continued retention of the Improving Bladder Control measure on the Display page should be considered temporary by plans. These measures continue to receive attention from CMS and measure developers and could easily be returned as Star Ratings Measures in the future — the Improving Bladder Control measure potentially as early as the 2018 Star Ratings and the HRM measure potentially as early as the 2020 Star Ratings.
As is always the case with CMS’ announcements regarding potential changes to the Star Ratings program, we know final decisions will not be made until after the measurement periods are complete. To successfully cope with this reality, health plans must continue monitoring CMS’ updates and announcements in the upcoming Advance Notice and Final Call Letters while simultaneously enhancing current workflows to incorporate strategic elements of the proposed changes. As we learned last spring, CMS gives strong consideration to health plan feedback regarding any proposed changes to the Star Ratings program.
With the potential Star Ratings changes on the horizon, this is a great opportunity to revisit your 2016 Star Ratings work plan to ensure you are ready for success. It’s a great time to evaluate reports, analytics, member/provider workflows and targeting, and budgets to make sure you’re prepared to earn your 4-Star Rating next year.
Resources
Gorman Health Group’s team of experts can help your organization adapt to the new clinical areas emphasized in the Request for Comments, develop or enhance care coordination within your programs, or evaluate the effectiveness of your current Star Ratings program. We can also help you educate your staff and providers on the nuances and clinical implications of these new measures. Visit our website to learn more >>
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