The 2015 Ratings are In: Have the Stars Aligned?

The Centers for Medicare & Medicaid Services (CMS) has released the 2015 Medicare Advantage Star Ratings, and the Stars seem to be aligning with CMS’ goals of the Star Ratings program.  For the 40% of Medicare Advantage plans earning at least 4 Stars this year, and thus qualifying for Quality Bonus Payments, these newly-released Star Ratings illustrate the value of health plans’ investments in clinical innovation and quality improvement within Medicare Advantage product offerings.

The 2015 ratings show stable or improved performance in almost 70% of the 46 Part C & D Star measures, 7 of which improved by more than one-half star from 2014 to 2015 and 13 of which earned average ratings above 4 stars in 2015.  Improved health plan quality is illustrated by strong performance on preventive screening and testing measures across all domains, health plan performance measures, and measures of member complaints.  During 2015, almost 60% of beneficiaries will be enrolled in one of the 158 Medicare Advantage plans which have earned at least a 4 Star Rating.

Despite these areas of strength and improvement, the Stars are not entirely aligned in the 2015 Ratings.  The 2015 Ratings spotlight the ongoing challenges plans continue to face in the following areas:

  • Managing chronic conditions
  • Managing mental health to improve mental health outcomes
  • Increasing physical activity and reducing fall risk

CMS continues to compel health plans to hardwire quality improvement and operational excellence by announcing adjustments to Star measures upon release of the ratings.  With the 2015 ratings, CMS has again made Star ratings history by re-weighting the Improvement measures to 5x and announcing the following changes:

  • SNP Care Management measure added with single weight
  • Breast Cancer Screening and Beneficiary Access/Performance Problems measures removed from ratings and reclassified as Display Measures
  • Glaucoma Testing and Call Center Foreign Language Interpreter and TTY Availability measures removed from ratings
  • Adjustments made to methodology on Annual Flu Vaccine, High Risk Medication and Medication Adherence measures

With the overall national average for HOS measures below 3 stars in 2015, combined with the changes to 2016 Star measures announced in the 2015 Call Letter, the time is right to acknowledge the potential return on investment from activities aimed at improving performance across all aspects of health plan performance.

The 2015 Star Ratings continue to show opportunities for health plans to break through long-standing silos within our organizations and throughout the industry.  Health plans can maximize Star Ratings by leveraging existing infrastructure, teams and processes to improve integration with providers and members.  Through innovative tactical adjustments to existing processes and work streams, health plans can better integrate Part C activities with Part D activities, physical health care plans with mental health care plans, and internally-staffed work streams with delegated work streams.

Despite the approximate 85% decline in plans receiving the low performing icon (LPI), 135 plans remain on the Quality Bonus Payment bubble at 3.5 stars in 2015.  Whether your plan’s 2015 Star Rating is on the bubble or solidly above 4 stars, this is an excellent time to re-evaluate your 2015 strategies, work plans and tactics to best ensure that your Stars remain aligned.

 

Resources:

The Centers for Medicare & Medicaid Services (CMS) has been aggressively working in the background to establish the Star Ratings program for the Health Insurance Marketplaces. See what you can expect >>

Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>