2024 Star Ratings: How to Bounce Back and Grow Membership

The Centers for Medicare & Medicaid Services (CMS) Star Ratings are a quality measurement system used by the Centers for Medicare & Medicaid Services to evaluate and compare the performance of Medicare Advantage (MA) and Part D prescription drug plans. The ratings are designed to provide beneficiaries with information about the quality and performance of these plans to help them make informed decisions. Star Ratings play a crucial role in incentivizing plans to provide high-quality care and helping beneficiaries select plans that align with their healthcare needs.

The 2024 Star Ratings announced by CMS on October 13 revealed a widespread decrease in ratings for all plans, primarily attributed to post-pandemic policy changes, the Tukey outlier deletion method, and deliberate CMS efforts to minimize costs. These factors collectively impacted the performance assessments of Medicare Advantage and Part D prescription drug plans, leading to lower overall Star Ratings.

2024 Rating Factors

1. Ending Pandemic-Era Flexibilities

CMS has an "extreme and uncontrollable circumstances policy" pertaining to the CMS Star Ratings. Under this policy, CMS may adjust the Star Ratings for plans affected by such circumstances. The adjustments can involve updates like exclusions or weighting changes in certain performance areas or removing certain data from the rating calculation. CMS uses this policy to ensure plans are not unfairly penalized for factors outside their control.

2. Tukey Outlier Deletion Methodology

Cut points in the CMS Star Rating system are thresholds that determine the Star Ratings assigned to Medicare Advantage and Part D prescription drug plans. The cut points are typically based on the distribution of plan scores each year, and they help categorize plans into different Star Rating levels (e.g., 5 stars, 4 stars, etc.). When the Tukey outlier deletion method is applied to the data, it identifies and removes extreme outliers. By removing these extreme values, the distribution of the remaining data is adjusted. This can result in a more "trimmed" dataset with less variability caused by outliers. In some cases, it may lead to higher cut points, making it more challenging for plans to achieve higher Star Ratings.

3. Cost Reducing Policy Updates

CMS uses policy updates to the Star program to reduce bonus payments and protect the Medicare Trust Fund by setting stricter performance standards and emphasizing cost-effective measures. By raising the bar for bonus qualification, plans are incentivized to improve care quality while also controlling costs. Adjusting the weightings of specific measures can encourage preventive care and chronic disease management, leading to savings in the long run. Regular updates in the Star Ratings methodology ensure that it aligns with evolving healthcare practices, promoting higher-quality care without overextending the Medicare Trust Fund's financial resources.

Star Ratings and Annual Enrollment

In addition to receiving quality bonus payments, achieving high Star Ratings provides a lucrative MA enrollment advantage.

1. Extended Enrollment Periods

In most cases, the annual enrollment period extends from October 15 to December 10, but MA plans with a 5-star rating are eligible for a special enrollment period from December 8 to November 30 of the following year. This means 5-star plans can attract new members throughout most of the year.  

2. Quality Bonuses

The Stars program incentivizes high-quality care based on evidence-based measures compromised of HEDIS, PQA, and member-survey responses. Plans that score well stand to collect bonus payments in the millions, resulting in enriched benefit packages.

3. Medicare.gov Advertising

Star Ratings for MA plans are displayed on the medicare.gov website, meaning beneficiaries shopping for health coverage can compare Star Ratings across plans available in their area.  

4. Premiums

Plans with higher Star Ratings receive a positive adjustment to cost benchmarks, which offsets the consumer premiums. For many beneficiaries shopping for health coverage premiums, this is a primary decision-making factor.

Planning for 2025 Ratings and Beyond

Plans that want to improve their ratings and grow membership don’t need to reinvent the wheel but should focus on the fundamentals of high-quality care. With the right combination of continuous operational scrutiny and performance management solutions like the Jiva Care Quality Navigator, plans can bounce back.

1. Monitor Performance Projections

Project measure performance to achieve higher CMS Star Ratings by identifying potential areas of improvement and allowing for targeted interventions to raise quality scores. This enables proactive adjustments to address deficiencies and optimize performance, which can positively impact a plan's overall star rating.

2. Overcome Care Barriers

Invest in analytics to identify and overcome care barriers by uncovering trends, disparities, and areas of underperformance within the patient population. By leveraging these insights, health plans can tailor interventions and care coordination strategies to target specific issues, ensuring the needs of various patient groups are met effectively.

3. Implement Health Equity Initiatives

Address and measure disparities by implementing initiatives that target underserved communities and cohorts focusing on improving access to care, health literacy, and reducing disparities in preventive care. Combined with a culturally competent approach that respects diversity and promotes cultural sensitivity, these efforts will position plans to perform well on the Health Equity Index reward.

4. Maximize Member Touch Points

Integrate solutions to streamline member touch points by consolidating and coordinating various aspects of care. This ensures members receive consistent, well-coordinated care, leading to a more comprehensive understanding of their health needs, timely interventions, higher satisfaction, and improved overall care.

By understanding the changing landscape, plans can proactively plan for measure years ahead. Bouncing back will require nimble strategies that leverage data analytics, prioritization of health equity initiatives, and integrated solutions to ensure every interaction with a member contributes to their quality goals. Plans that want to grow their membership will need to ensure their CMS Star performance allows them to realize available enrollment perks and competitive advantages.