The pandemic continues to have a profound impact on healthcare and that includes the Centers for Medicare and Medicaid Services’ (CMS’) Star Ratings program for Medicare plans. CMS released the 2022 Star Ratings last week and they may have looked a little different than previous years. That’s because the 2022 Star Ratings are based on performance in 2020 when the COVID-19 pandemic began, placing all Medicare plans in an emergency situation.
CMS has two rules for dealing with natural disasters or emergency situations, such as the pandemic: the 60 percent rule and 25 percent rule. Both are based on the percentage of a plan sponsor’s membership living in an emergency area, either 60 percent or 25 percent. The difference is, with the 60 percent rule, CMS excludes non-Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures, whereas with the 25 percent rule, CMS uses whichever measure-level rating is higher between the current and previous year for all non-CAHPS measures.
Because the whole country was impacted by the pandemic, if the 60 percent rule were applied there would not be enough data to determine Star-level thresholds. So for the 2022 Star Ratings, CMS excluded the 60 percent rule and applied the 25 percent rule. With this rule in effect, plans were evaluated based on whichever measure-level rating was higher from 2021 (performance in 2019) or 2022 (performance in 2020).
What Does the Future of Star Ratings Hold?
Since the pandemic is ongoing, who knows what will happen in 2023. That makes having data available about how your plan is faring in various measures with different cut points even more important than ever. With Elixir’s Stars Targeted Analytics & Reporting (S.T.A.R.) tool you can prepare for whichever direction the Star Ratings might go, previous cut points, new cut points or current measures. This insightful tool provides on-demand actionable data on your Star Ratings per measure and allows you to project what it would take to achieve a higher Star Rating, what adverse changes could lower your rating and estimate how different cut points (current, past or future estimates) could impact your ratings. In addition, there is real-time reporting on member fill rates that can be indicative of over- or under-utilization, including opioid utilization, Prescription Drug Event (PDE) results, and adherence rates for members using diabetes, hypertension and cholesterol medications, as well as diabetics who are not utilizing a statin.
Medication Adherence Matters
No matter which plan year is being reviewed, one thing’s for certain—the Medication Adherence measures that rate a member’s adherence to diabetes, hypertension and high cholesterol medications remain a large portion of the overall Star Rating, as well as the Statin Use in Persons with Diabetes (SUPD) measure. The good news is, the national average indicates that the 2022 Star Ratings are greater for these measures compared to 2021.
Continuing to maintain medication adherence can help your Star Ratings soar. Elixir’s Adherence Intervention Management (AIM) solution uses the Pathways Engine, our predictive analytics and machine learning platform, to identify members at-risk for nonadherence to the measured medications who are most receptive to interventions, the interventions they are most likely to respond to and their preferred communication channel. Then our specially trained Care Navigators provide personalized outreach to encourage ongoing medication-taking behavior, improving the whole health of our members while increasing Star Ratings for clients.
Beyond the Medication Adherence measures, CMS continues to raise the cut points for Comprehensive Medication Review (CMR) completion rates. On average, CMR completion rates were also higher in 2022. It is important to have a Medication Therapy Management (MTM) program that gets results to maintain this important Star measure. Our MTM-certified Care Navigators contact members directly for CMRs and adherence interventions, providing advice on medications, answering prescription questions, discussing side effects and cost savings opportunities, helping with barriers to medication adherence, closing gaps in care, and improving Star Ratings.
A Partner for Uncertain Times
While the future of Star Ratings might be unpredictable, having the technology to monitor your Star Ratings in real-time and estimate performance, as well as personalized, targeted member outreach can help you be prepared for an uncertain future.