Make sure to message all unpleasant 2023 changes to members through direct and meaningful interactions so no member is surprised when they seek care or visit their pharmacy in 2023. RESOURCES FOR HEALTH PLANS NCQA's Health Plan Ratings 2023 include commercial, Medicare and Medicaid health plans. hbbd```b``z "sA$2D27eHvfs$+_E`Z 7AdH%y; F An official website of the United States government. Section 3014 of the Patient Protection and Affordable Care Act establishes the CMS Pre-Rulemaking process for the selection of measures for adoption in U.S. Department of Health & Human Services programs. With the significant changes in healthcare and clinical care patterns in 2022, there is no reason to thinks that Measurement Year (MY) 2021 historical experiences are as useful as benchmarks for MY2022 expected performance without making adjustments to account for post-COVID return to reality. Every day and week matters to make sure your plan gets or stays on a strong trajectory. The agency is also considering adding the ADI to the Medicare Advantage Star Ratings, which it says could save Medicare $5.13 billion over 10 years. Sonja Pedersen-Green is an associate partner in McKinseys Minneapolis office, and Cara Repasky is a partner in the Pittsburgh office. lock A careful comparison of the measurement categories called out by CMS in this paragraph of the Technical Notes offers a reminder of the many critical areas for which there are few, or no, measures currently in the Star Ratings program. Click here for information regarding the transitions to ECDS reporting. Many plans are still working too hard trying to keep up with other health plans. ) [2] See CY 2020 and 2021 final rule (CMS-4185-F) at Federal Register :: Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Programs of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021. The Complaints about the Plan measure is a rate of complaints about the plan per 1,000 members. For more information, refer to the full measure specifications in HEDIS MY 2023 Volume 2: Technical Specifications for Health Plans and/or HEDIS MY 2023 Digital Measures Bundle. But cutpoints are nothing more than a reflection of historical relative performance. Star ratings and Tukey's disappearing act - RISE Health If outlier removal and guardrail methodologies had been in place, the cut point increases would have been much smaller, making it more difficult for contracts to achieve higher Star ratings. This means that the limitation on the use of better of and the implementation of cut point guardrails will take effect for rating year 2023 based on 2021 performance data. CMS has indicated retirement of the stand alone MRP for MY24 Osteoporosis ManagementStatin Therapy forCardiovascular DiseaseFollow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions TransitionsofCareNIARDI Measure determinedaverage of PEDthe four display measures to the MRP right Plan All-Cause Readmissions The last row in Table 4 shows the trend in the average overall Star Ratings weighted by enrollment for MA-PDs from 2020 to 2023, after any adjustments for extreme and uncontrollable circumstances. For details on the Medicare Advantage (MA) and Part D Star Ratings, please refer to the 2023 Part C & D Star Ratings Technical Notes available at http://go.cms.gov/partcanddstarratings. Both are currently on the display page and will remain on the display page through 2023. Approximately 51% of MA-PDs (260 contracts) that will be offered in 2023 earned 4 stars or higher for their 2023 overall rating. This process ensures that they remain relevant and feasible for implementation. For many plans, particularly those that have yet to regain footing in their quality programs during the pandemic, the financial impact will be substantial. 4/24/2023. Share this page with a friend or colleague by Email. Table 1: Changes in Part C Measure Scores from 2021 to 2023 Star Ratings for MA Contracts, Increase / Decrease in Performance from 2022 to 2023, Statin Therapy for Patients with Cardiovascular Disease*, Medication Reconciliation Post-Discharge*, Plan Makes Timely Decisions about Appeals, Diabetes Care Kidney Disease Monitoring*, Call Center Foreign Language Interpreter and TTY Availability, Care for Older Adults Medication Review*, Osteoporosis Management in Women who had a Fracture*. In rating year 2023, when this better of methodology no longer applies universally, average contract Star ratings may revert from the average of 4.37 across all contracts in rating year 2022 to 4.074.17, their levels during rating years 201921, before the methodology was expanded to accommodate the pandemic. April 1, 2021 This week, our In Focus section highlights changes that may affect the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Rating program and how these changes impact future summary Part C & D Star Rating scores. In fact, the impact was heavily concentrated on a small number of measures, illustrating that changes to the cut points of even a few measures can have a significant impact on Star ratings. Member engagement and member satisfaction are year-round endeavors. During this time, Medicare beneficiaries can compare coverage options, including Original Medicare and Medicare Advantage, and choose high quality health and drug plans for 2023. Also, you can decide how often you want to get updates. Future Proof your 2023 and 2024 Stars Workplans through active sessions with your colleagues to be prepared for success amidst the many changes on the horizon. * Measures from HEDIS and CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE). CMS News and Media Group For parent organizations with multiple contracts, its often small and inconsequential contracts where new work is going to need to be performed to prevent the entire parent organizations expansion plans from being placed at risk due to this provision. Catherine Howden, DirectorMedia Inquiries Form The Centers for Medicare & Medicaid Services (CMS) Measures Under Consideration (MUC) Entry/Review Information Tool is now open for 2023 quality and efficiency measure submissions! The Centers for Medicare & Medicaid Services (CMS) uses a Star rating system to measure the performance of Medicare Advantage (MA) plans. An increase in scores for these 2 measures is a decrease in performance. 2022 CMS Star Ratings, Impact, and Implications - Icario Secure .gov websites use HTTPSA Read our fact sheet to learn how Cotiviti's Star Intelligence enables health plans to: HEDIS publications are available as electronic publications. 2022 DQA on behalf of ADA, all rights reserved. You can decide how often to receive updates. A 2019 report by the Kaiser Family Foundation found that the gross margin for Medicare Advantage plans was $1,608 per covered person. 2023 CMS Star Ratings - 4 Things You Need to Know | Icario Integrate Tukey calculations into MY2022 reporting and goal setting to ensure that fourth quarter initiatives drive success. C.b`Q ` 3 Centers for Medicare & Medicaid Services (CMS) does not arbitrarily set cutpoints, but rather collective performance on each measure determines cutpoints. Our analysis suggests that deteriorating CAHPS performance could have a significant impact on MA plans overall Stars performance. Ilene MacDonald, Editorial Director | August 09, 2021 In an August 5 memo to all Medicare Advantage (MA) plans, the agency announced that the COVID-19 public health emergency significantly impacted the validity of measures related to physical and mental health currently used in the Star Ratings. Stakeholders recommended that CMS modernize the survey prior to . The overall rating is the weighted average of a plan's HEDIS and CAHPS measure ratings, plus bonus points for plans with a current Accreditation status as of June 30, 2023. NCQA invites you to join HEDIS Users Group for inside information on HEDIS development and future directions. The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). Table 2: Changes in Part D Measure Scores from 2021 to 2023 Star Ratings for MA-PD Contracts, Increase/ Decrease in Performance from 2022 to 2023, Medication Adherence for Cholesterol (Statins), Medication Adherence for Diabetes Medications, Medication Adherence for Hypertension (RAS antagonists). The Star Ratings system supports CMS efforts to empower people to make health care decisions that are best for them. Quality relies on the orchestration of a host of factors. Data from the 2019 through 2021 measurement periods help us understand how the PHE impacted the care delivery system. MA contracts with 4.0-Star ratings would be particularly affected financially by these changes due to the loss of the 5 percent quality bonus (which 3.5-Star contracts are not eligible for). 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Prescription Drug Coverage - General Information, Part D Information for Pharmaceutical Manufacturers, Pharmaceutical Manufacturer Patient Assistance Program Information, Stratified reporting documentation - 2022-2023 Star Ratings (PDF), 2024 Categorical Adjustment Index Measure Supplement (PDF), 2023 Medicare Star Ratings Fact Sheet (PDF), 2023 Categorical Adjustment Index Measure Supplement (PDF), 2022 Star Ratings Fact Sheet_10_8_2021 (PDF), 2022 Star Ratings Technical Notes (Oct 4 2022) (PDF), 2022 Star Ratings Data Table (Oct 06 2021) (ZIP), 2022 Categorical Adjustment Index Measure Supplement (PDF), 2021_Star_Ratings_Fact_Sheet 10 13 2020 (PDF), 2021 Star Ratings Data Table (Oct 08 2020) (ZIP), 2021 CAI Measure Selection Supplement (PDF), Star Ratings Technical Notes (Oct 10 2019) (PDF), 2020 Star Ratings Data Table (Oct 21 2019) (ZIP), 2020 CAI Measure Selection Supplement (PDF), 2019 Part C and D Medicare Star Ratings Data (v04 12 2019) (ZIP), Industry-wide Appeals Timeliness Monitoring Memo (November 28, 2016) (PDF), Industry-wide Timeliness Monitoring (PDF), 2018 Star Ratings and Display Measures (ZIP), 2017_Star_Ratings_and_Display_Measures (ZIP), 2016_Star_Ratings_and_Display_Measures (ZIP), 2015_Star_Ratings_and_Display_Measures (ZIP), 2014_Star_Ratings_and_Display_Measures (ZIP), 2013_Plan_Ratings_and_Display_Measures (ZIP), 2012_Plan_Ratings_and_Display_Measures (ZIP), 2011_Plan_Ratings_and_Display_Measures (ZIP), 2010_Plan_Ratings_and_Display_Measures (ZIP), 2014 RFI Submissions (02252015) v2a (ZIP), Historical Categorical Adjustment Index Documents (ZIP). In 2023, with the Star Rating removals, temporary suspensions, and proposed additions, Member Experience measures will account for 60% of the ratings. This measure is included in the Medicaid Child Core Set. However, for plans that successfully adapt to a more demanding Star ratings environment, quality may emerge as a source of competitive advantage. * Measures from CAHPS used data from the 2020 Star Ratings (collected in 2019 and unaffected by the COVID-19 PHE). Healthcare Payer Resource Center | Cotiviti. PDF UPDATES TO THE CMS STAR RATING SYSTEM AND METHODOLOGY - Cigna Section 3014 of the Patient Protection and Affordable Care Act establishes the CMS Pre-Rulemaking process for the selection of measures for adoption in U.S. Department of Health & Human Services programs. The removal of the above measures boosted the importance, with Member Experience measures now accounting for 43% of all measures. Marina Ivanenko, Dan Jamieson, and Cara Repasky, , New Stars ratings for Medicare Advantage prioritize customer experiences. This is the time to really know your plans mission, vision, and strategic plan and align Stars workplans with leadership. Share sensitive information only on official, secure websites. Federal government websites often end in .gov or .mil.