Star Ratings Blog 2023
On October 13th, the Centers for Medicare and Medicaid Services (CMS) released the annual Star Rating reports for health plans in anticipation of the Medicare Advantage Open Enrollment period which started on October 15th.
Star Ratings 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). According to CMS Administrator Chiquita Brooks-LaSure, “the Medicare Advantage and Part D Star Ratings are important tools to help people find the right option for their needs and circumstances, and make informed health care decisions.”
Unfortunately, for the second year in a row, the average Star Ratings continue to decrease, post-pandemic. The scores decreased from an all-time high in 2022 of 4.37 to 4.14 for 2023 to 4.04 for 2024.
- There are six contracts identified for consistently low-quality ratings, compared to last year, only one contract was identified for having consistently low-quality ratings
- Approximately 27% of PDPs (13 contracts) that will be active in 2024 received 4 or more stars for their 2024 Part D Rating, compared with 42% of MA-PDs (229 contracts).
- Interestingly, there is a correlation between tax status and performance.
- For MA-PDs, approximately 56% of non-profit contracts received 4 or more stars; 36% of for-profit MA-PDs received 4 or more stars.
- Approximately 50% of non-profit PDPs received 4 or more stars; 14% of for-profit PDPs received 4 or more stars.
There are vast opportunities for improvement for health plans. However, improvement on new measures around population health can be one key strategy: Transitions of Care, Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions, and Plan All-Cause Readmissions. Since this is the first year health plans were held accountable for these measures, the overall ratings are relatively low, compared to the existing measures. Health plans will need to work with primary care providers to continue to implement population health strategies for patients after a hospital visit.
In order for the quality of care to truly be impacted and improved, patients, providers, and health plans must come together. It will truly take a collaborative effort, data transparency, and improved care coordination for the quality of care to increase. Technology will play a critical role in quality improvement, and it is important to find the right technology partner to bring together patients, providers, and health plans.