Star Ratings are the highest they have ever been. Due primarily to the unprecedented impact of the Covid19 pandemic, the number of health plans with a five-Star rating are in abundance for 2022.
Sixty plans now have a five-star rating in 2022 that did NOT have this distinct designation in 2021 (a 192% increase). Additionally, nearly 70% of Medicare Advantage plans now have four or more Stars and approximately 90% of MAPD members are enrolled in plans with four or more stars for 2022.
In addition to the Covid19 effect, health plans have made strides in the following areas that have helped with Star ratings:
- Providing better access to medication and assisting with medication adherence
- Focusing on clinical care for chronic conditions
- Optimizing the member experience
A few outliers
There were only three contracts that saw a drop in ratings due to a CMS ruling change. And these health plans took legal action with not-so-great results.
As the pandemic kicked off in March 2020, CMS changed the rules regarding how star ratings were calculated. Physicians, clinics, health centers and others were given broader flexibility in using remote communications technology to avoid the potential risk of in-person contact.
CMS decided to calculate 2021 ratings using HEDIS and CAHPS data collected in 2019.
So, in June of 2021, three Medicare Advantage plans tried to have this decision overturned and a federal judge ruled against them.
The result? Two of the MA plans that went to court had Star rating declines from 2020 to 2021. The third plan stayed at 2.5 Stars for three years in a row, reducing plan payments and bonuses from CMS and elevating their risk of being terminated from the MA program. These plans sued because they thought their Star ratings would have been higher if more recent HEDIS and CAHPS data had been included.
Even in normal non-pandemic times, CMS has flexibility in how it uses data to determine Star ratings—meaning CMS could continue to halt in-person data collection. Doing so could potentially change how Stars are calculated.
Let’s look at another area impacting Star ratings: Agent-member engagement.
An Agent’s Impact on Star Ratings
Even with higher Star ratings, churn is also higher than ever. Higher-rated contracts tend to enroll healthier, less socio-demographically disadvantaged beneficiaries. Members with the worst health status disproportionately disenroll. This is one reason why Social Determinants of Health are becoming increasingly important in keeping members with their plans.
Agents are the face of Medicare plans, and how they interact with members can impact plan performance. Costly disenrollments could be avoided by: 1) improving an agent’s ability to connect members to the information and support they need, and 2) assisting members at every touch point in the member journey.
And, as voluntary disenrollment is a key Star measure, CMS rewards plans with low disenrollment.
CAHPS surveys are also critical to Stars. When agents help members understand their plan benefits and focus on the importance of having a primary care provider, members tend to respond positively on CAHPS surveys.
Measures that focus on health outcomes and the member experience are rated more heavily than other performance measures and health plans must continue to invest heavily in both the member and provider experiences. Important considerations are medication adherence, telephonic outreach and pharmacy interactions. Meeting members where they are and in the way they want to communicate (online, text, in person, phone, etc.) is critical to getting an appropriate positive response.
Here’s how agents can most effectively impact Star ratings:
- Ensure all information is accurate on enrollment forms
- Thoroughly explain benefits and out-of-pocket expenses
- Discuss scheduling wellness exams with Primary Care Providers
- Explain that the health plan may reach out occasionally to assist with preventive care needs and handle medication reconciliation
- Assist members with finding their best fit plan from the start. This strengthens the agent-member relationship and helps build trust and brand loyalty.
- Encourage members to complete a Health Risk Assessment (if applicable). Star ratings are based, in part, on specific services such as annual screenings and medication adherence.
- Help reduce complaints by adhering to what is required in all sales appointments
Invest now for 2023
Even with 2022 higher-than-ever Star ratings, health plans must stay vigilant and continue to invest in the member experience. If plans do not, there will be many falling Stars in 2023. Consider 2022 an overinflation of ratings so a drop can be expected in 2023. The member experience will be the most critical driver of Star ratings counting for 43% of all measures (previously at 37%).
Competition will be fierce from newer, more nimble plans. CAHPS will continue to be more important than ever with Spring 2022 CAHPS survey results driving more than 33% of a health plan’s Star rating. This is why the meaningful interaction with agents can make a difference.
At ConnectureDRX, we focus intently on the member experience, offering targeted and relevant solutions for every touch point along the member journey. We hope you’ll download our whitepaper on how health plans can improve the member experience and elevate Star ratings here.
CMS Star Ratings Fact Sheet
Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the Covid-19 Public Health Emergency https://www.federalregister.gov/documents/2020/04/06/2020-06990/medicare-and-medicaid-programs-policy-and-regulatory-revisions-in-response-to-the-covid-19-public
Federal Court Upholds Changes to Medicare Advantage Star Ratings During the Covid-19 Pandemic https://www.commonwealthfund.org/blog/2021/federal-court-upholds-changes-medicare-advantage-star-ratings-during-covid-19-pandemic
UHC Agent 2022 Star Ratings
2022 CMS Star Ratings, Impact and Implications
2022 CMS Star Ratings, Impact, and Implications (icariohealth.com)
2022 Star Ratings: 3 Things to Know & 3 Things to Do
2022 Star Ratings: 3 Things to Know & 3 Things to Do (healthmine.com)