The landscape of CMS Star Ratings for Medicare Advantage plans with prescription drug coverage (MA-PD plans) witnessed a shift in 2024, with the average Star Rating dropping from 4.14 in 2023 to 4.04. This decline, affecting 45% of plans earning four stars and more than one-third experiencing a rating drop of half a star or more, underscores the evolving nature of the ratings system.
Unraveling the Factors Behind the Ratings Decline
The 2024 results were influenced by multiple factors, including the aftermath of policies inflated during the pandemic's peak and a modification in the ratings methodology. This year, the Centers for Medicare & Medicaid Services (CMS) implemented changes in calculating cut points using the Tukey outlier deletion method, a statistical technique. This adjustment resulted in more than half (50%) of cut points increasing, creating a ripple effect across various measures.
Anticipating Key Changes for 2025 and Beyond
Looking ahead, the 2025 Star Ratings will introduce new, revised, and returning metrics that could reshape the landscape for MA plans. Notable measures include Colorectal Cancer Screening reported exclusively in electronic clinical data systems (ECDS) format, a new Kidney Health Evaluation for patients with diabetes, and changes in continuous enrollment requirements for measures like Statin Use and Medication Adherence.
Moreover, Patient Experience/Complaints and Access measures will see reduced weight, and health outcome survey (HOS) measures related to physical and mental health are returning as 1x-weighted measures. These alterations underscore the need for plans to adapt and strategize effectively to meet the evolving criteria.
Strategies for Success in the Face of Change
In light of these changes, plans must adopt proactive strategies to navigate the evolving Star Ratings methodology:
Foster a Culture of Continuous Quality Improvement:
Empower Star Ratings teams to lead a culture of continuous improvement.
Assemble cross-functional teams for year-round coordination of quality improvement efforts.
Look Ahead to 2026:
Develop long-range strategies considering proposed changes and evolving measures.
Anticipate the impact of future changes, such as the increased weight of HEDIS measures.
Baseline and Benchmark:
Conduct a comprehensive assessment of performance against clinical and nonclinical measures.
Benchmark results against national trends and competitors to identify areas of opportunity.
Prioritize Impactful Measures:
Use predictive analytics to project Star Ratings and prioritize efforts on measures with the most significant impact.
Identify measures that require minimal improvement for a star increase and focus on care gaps for specific members.
Staying Ahead of the Game
While some plan leaders may find the 2024 results discouraging, leveraging insights from predictive analytics can provide a strategic advantage. By staying ahead of methodological changes and prioritizing impactful measures, plans can not only enhance their Star Ratings but also foster provider alignment and improve the overall member experience. This proactive approach positions plans for success in the dynamic landscape of CMS Star Ratings in 2025 and beyond.
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