cms stars measures 2023

2023 Star Ratings: What to Know and What to Do Now, sound the alarm bell loudly and immediately to leadership, decreased dramatically and pervasively this year, 60% of Medicare beneficiaries will be enrolled in Medicare Advantage (MA) plans by 2032, CMS $4.1 billion in quality bonus payments by 2030, Risk Adjustment 101: What Medicare Advantage Plans Need to Know, Identifying Opportunities for Improvements With Health Outcome Surveys, Star Ratings and The Risk of Being Too Tactical, Guide Member Health Journeys With Digital Health Apps, Build an Effective Business Case for Additional Stars Resources. Note that enrollment-weighted Star ratings may differ slightly from CMS reports due to enrollment data used in analysis. The Centers for Medicare & Medicaid Services (CMS) released the 2023 Star Ratings for Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug plans to help people with Medicare compare plans ahead of Medicare Open Enrollment, which kicks off on October 15. An analysis of CMS 2023 Medicare Advantage and Part D Star Ratings Fact Sheet shows that the national average measure score for breast cancer screening was down 0.74 compared to 2022 and down 4.3 compared to 2021. 422.166(h)(1)(i), 423.186(h)(1(i). For MY 2023, HEDIS added five new measures, retired five measures, substantially changed a measure and made small changes across multiple measures. Stars measurement and rating procedures are specified in Chapter 42 of the Code of Federal Regulations, Part 422, last amended August 10, 2022. CY 2023 Medicare Advantage and Part D final rule (CMS-4192-F), CMS, April 29, 2022. %PDF-1.6 % Weighted by enrollment, approximately 72% of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2023. All Star Ratings referenced in Tables 10, 11, and 12 are after the adjustments to address concerns about collecting CAHPS and HEDIS data for the 2021 Star Ratings, regulatory adjustments for extreme and uncontrollable circumstances triggered by the COVID-19 PHE for the 2023 Star Ratings (for non-HOS measures), and the regulatory disaster adjustments for extreme and uncontrollable circumstances triggered by the COVID-19 PHE for HOS measures, and other qualifying extreme and uncontrollable circumstances,[9] for the 2021 performance period have been applied. H\j@}l/BB.(s?f`D[Sn}fScw9 :bP,jyK;e Medicare Advantage Star ratings may decline with new methodology. CMS allowed contracts to take the better of Star rating between 2021 and 2022 for most measures.1Fact sheet - 2022 Part C and D Star ratings, CMS, October 8, 2021. Prescription Drug Coverage - General Information Part C and D Performance Data Part C and D Performance Data This page contains performance data related to the Part C & D programs. 820 0 obj <> endobj Improvement in CMS Star Ratings isnt about any one thing. For example, all six measures in Domain 3 showed an average decline during the last CAHPS survey that ran from March through June 2022: Meaningful drops in Getting Needed Care and Getting Appointments and Care Quickly speak volumes about the struggles plans have had maintaining strong provider networks in an environment where practitioners are in short supply. CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. Capital District Physicians' Health Plan, Inc. HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC. University of Wisconsin Hospitals and Clincs Autho. **For Complaints about the Plan and Members Choosing to Leave the Plan a lower score is better. Use your new Second Plan Preview urgency to hyper-index on specific measures, priorities and 2023 needs that may have languished amidst the struggle of remote work. Hong Kong's flagship carrier parked much of its fleet during the pandemic due . HEDIS publications are available as electronic publications. Read our fact sheet to learn how Cotiviti's Star Intelligence enables health plans to: Starting with the 2024 Star Ratings (2022 measurement period), CMS made it more difficult for plans to meet the performance standards necessary to retain or raise Star Ratings by removing performance outliers of non-CAHPS measures from the Tukey methodology's calculation of Star Rating cut points. The newest additions to HEDIS address pediatric dental care, safety and appropriateness, diabetic care and social needs screenings and interventions. This measure will allow plans to understand if their pediatric members are receiving dental care and to work towards improving access and utilization of dental evaluations. Many plans are still working too hard trying to keep up with other health plans. Additionally, starting in 2023 under the Inflation Reduction Act, people with Medicare prescription drug coverage will have improved and more affordable benefits, including a $35 cost-sharing limit on a months supply of each covered insulin product, as well as adult vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) at no additional cost. Plans know their Star Rating, causing either extreme joy or panic, and measure-level national performance trends are now known. NCQA invites you to join HEDIS Users Group for inside information on HEDIS development and future directions. CMS also warns of the imminent transition to digital quality measurement, which will apply to both clinical and survey measurements within the next few years and for which NCQA has openly supported using Star Ratings and quality bonus payments as incentive for plans to switch to digital measurement. The Centers for Medicare & Medicaid Services (CMS) blames a codification error for the disappearance of the Tukey outlier deletion, a statistical method for removing outliers when calculating Star measure cut points, when the final rule for Medicare Advantage (MA) and Part D prescription drug programs was implemented on June 28. Data points that are more than 150 percent of the interquartile range above the third quartile are identified as outliers and removed, as are points less than 150 percent of the interquartile range below the first quartile. An increase in at-home stool testing appears to have offset some of the decline in colorectal cancer screening, but this measure also saw a 0.54 decline from 2021 and a 1.9 decline compared to 2020. The enrollment-weighted average Star rating held steady between 4.0 and 4.1, and the percentage of members in 4.0 Star contracts or higher was consistently 70 to 80 percent between rating years 2016 and 2021. In 2022, nearly 90% of Medicare Advantage beneficiaries were enrolled in an MA contract rated at 4.0 Stars or higher. However, the short-term impact overall is minimal in 2022 and 2023. To understand the potential effect of cut point methodology changes on MA contract Star performance, we retroactively analyzed the impact they would have had on performance in rating year 2020. Click Privacy Settings to see the types of cookies used and to update your cookie preferences for this browser. The arrows indicate whether the change in scores is positive or negative from the 2022 to 2023 Star Ratings. According to Hartnett, the ADI is a collection of data points created by the Health Resources and Services Administration to rank neighborhoods by socioeconomic . _4Mc:y?8yxMyM_a6YMOiv^)si|J7'o|L7:m86k:hcx%3"/v9]$/lo1r|!o;Wr*8:;8;88888888%kbaVfYaVfYaA9SLvtvt-yfGAGaGAGaGAGeGEGMpS)n Star Ratings awards a "Reward Factor" for consistently high performance. or . Published every year, the CMS Five-Star Quality Rating System measures the quality of health and drug services. Note that enrollment weighted Star ratings may differ slightly from CMS reports due to enrollment data used in analysis. 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 SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC. CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC. KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES, TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION. Sixty-nine of these contracts17 percent of contracts, enrolling 9 percent of beneficiarieswould have achieved a 0.5 lower Star rating in rating year 2020 (for example, achieving 3.5 Stars rather than 4.0 Stars) had Tukey and cut point guardrails been in place (Exhibit 3). While we await the full public release of the ratings, we know a great deal already. [4] The introduction of guardrails was initially finalized for the 2022 Star Ratings in the CY 2020 and 2021 final rule (CMS-4185-F). hbbd```b``z "sA$2D27eHvfs$+_E`Z 7AdH%y; F Members who call your call center, who are new to your plan, and who have experienced (or will experience) a change in their benefits are your most likely candidates for dissatisfaction. 2023 saw a return to more normal evaluations overall and a return to earth for MA-PD plans. FACT SHEET October 6, 2022 Contact: CMS Media Relations (202) 690-6145 | CMS Media Inquiries 2023 Medicare Advantage and Part D Star Ratings Note: The information included in this Fact Sheet is based on the 2023 Star Ratings published on the Medicare Plan Finder on October 6, 2022. Star ratings in 2022 were also affected by the increased relative weight of member experience measures. The scores are shown prior to any adjustments under the extreme and uncontrollable circumstances rules; thus, they reflect actual performance during the measurement period. Second Plan Preview is underway and has kicked off a flurry of energy and enthusiasm in pursuit of quality excellence in Medicare Advantage. New CMS Star Ratings were released on October 6 and offered a few surprises. Both systems allow plans to add points to their overall score. Daily Briefing . 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. But cutpoints are nothing more than a reflection of historical relative performance. There is no time to wait if you own one of these contracts and have any desire to expand in plan year 2024! Actual performance decreased so pervasively that the average Part C and D Improvement measure ratings decreased to 2.6 stars and 2.7 stars, respectively. Contracts used better of performance most frequently for CAHPS measures, a category that has been gradually increasing in weighting since 202011New Stars ratings, October 15, 2020. and will reach its target weight in 2023. Learn the steps health plans can take now to prepare their quality programs for success when CMS's proposed Core Measures and Universal Foundation are implemented. For example, in 2022, 73% of contracts achieved a Star Rating of 4.0 or better, but in 2023 only 51% did so. [7] 42 C.F.R. Copyright 2023 National Committee for Quality Assurance. 7500 Security Boulevard, Baltimore, MD 21244, CMS Releases 2023 Medicare Advantage and Part D Star Ratings to Help People with Medicare Compare Plans, People with Medicare can use the Medicare Plan Finder tool, available on, Medicare Open Enrollment begins October 15, 2022, and ends December 7, 2022. 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). The intentional alignment of Stars to the Meaningful Measures structure spotlights the many important clinical, behavioral, pharmacy and experiential areas for which reliable quality measures exist but have not yet been introduced to Star Ratings. In our retroactive analysis, the contracts most affected by cut point changes were those that received 3.5- and 4.0-Star ratings in rating year 2020; 23 percent of these contracts (enrolling 14 percent of beneficiaries) would have had been rated 0.5 Stars lower (Exhibit 4). For the 2023 Star Ratings, the only adjustments for the impact of the COVID-19 public health emergency (PHE) are the measure-level adjustments for three Healthcare Effectiveness Data and Information Set (HEDIS) measures derived from the 2021 Health Outcomes Survey (HOS). hb```e``zAb@`_j(@VEGszGGX,b0E10,geu:(GV~VU,5}Af';e0f"% dU Second, CMS will implement annual upper and lower limits, or guardrails, on changes in cut points for non-CAHPS5Consumer Assessment of Healthcare Providers and Systems (CAHPS), a survey that CMS uses to assess patient experience of care. CMS Star Ratings data (2013 to 2022) and September enrollment data (2013 to 2021). The Complaints about the health/drug plan measure would have been most affected in 2020 by cut point methodology changes, with 98 percent of contracts seeing performance on that measure fall by at least 0.5 Stars when changes were implemented (Exhibit 5). Stars Measure Changes . Average contract ratings began to stabilize after rating year 2016 as quality-improvement programs became necessary elements of a competitive MA offering. Every day and week matters to make sure your plan gets or stays on a strong trajectory. MA-PDs with 10 or more years in the program are more likely to have 4 or more stars compared to contracts with fewer than five years in the program. Note: The information included in this Fact Sheet is based on the 2023 Star Ratings published on the Medicare Plan Finder on October 6, 2022. See also the CY 2022 Rate Announcement at Announcement of Calendar Year (CY) 2022 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (cms.gov) (explaining how the change in the collection of HEDIS data in 2020 resulted in this measure being on the display page for the 2021 and 2022 Star Ratings to comply with 422.164(d)(2)). In 2023, CMS is set to increase the weighting of member experience measures in the Star Ratings System to promote value-based care. Third, CMS will remove performance outliers from the calculation of non-CAHPS measure rating cut points in rating year 20247Contract year 2021 Medicare Advantage and part D final rule (CMS-4190-F1) fact sheet, CMS, May 22, 2020. using the Tukey outlier deletion method.8Tukey outlier deletion is a statistical method for identifying and removing outliers based on the interquartile range of the set.

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