How the 2024 Star Ratings Results Should Influence Your Strategy

The 2024 Final Star Ratings release left the Medicare Advantage market in an uncertain state. The number of 5-star plans dropped in half from last year’s Star Ratings. Among MA plans offering Part D coverage, there are 11% fewer this year than in 2023. And after an all-time peak during CMS’ COVID relief, this is now the third year in a row we’ve seen overall Star Ratings decline.

The decline is due to a number of factors. Three new measures were added to the mix, one measure was retired and the Tukey Outlier Deletion changed cut points so significantly that it was harder for plans to earn 4 star ratings.  Here are a few important takeaways and what you should do next to prepare for success in Measurement Year 2024. Register for our upcoming webinar Explore Key Themes in the 2024 Star Ratings for an in-depth discussion on takeaways, performance trends and what to do next.

3 Key Takeaways from the 2024 Star Ratings:

1. Tukey caused immense impact. Though 95% of the Star measures experienced a change in the national average under 3%, more than 25% of the measure cut points increased by at least 5%. Despite nominal improvements in actual quality performance at a macro level, this suppressed average performance back to mid-2010 levels.  Though its implementation had extreme impact to this year’s ratings, this is a one-time event and should create increased stability in future years.
   
   
2. Three times more contracts saw decreased ratings than improved ratings. This results in 74 plans losing almost $1.5 billion in Quality Bonus Payments. Ratings decreased for 278 Medicare Advantage Prescription Drug (MA-PD) plans, while only 97 plans experienced increased ratings.  These headwinds resulted primarily from the heavy weight of Improvement measures, introduction of three new measures, and the impact of Tukey rebasing.
   
   
3. The Past Performance criteria proves influential. Though more plans than ever received the Low Performing Indicator, the impact of these ratings on CMS’ Past Performance criteria rolled out in 2023 is even more impactful. 145 contracts received a Summary or Overall Rating that triggers the Past Performance criteria used by CMS to approve New Contract and Service Area Expansion Applications.

What to Act on Quickly:

Don’t take these last few months of the year for granted. There is still significant time left for MA plans to build comprehensive strategies going into 2024 to make the most of the next measurement year.

• Assign one person to focus on finishing 2023 strong, and a different person to finish preparing for the very different Stars strategy needed in 2024.  Expecting one person to simultaneously succeed on the immediate-term tactics while also finishing the longer-term strategy work needed to adapt to 2024 Stars changes is likely unrealistic and will delay success.
• Strengthen Q4 and Q1 efforts in areas still in play. There are many ways to optimize almost every measurement area! From CAHPS and HEDIS to administrative and Part D, there is time to gather documentation of completed services, help members get connected to the care and medications they need, and redirect efforts if needed to achieve your goals. Increase attention on 1- and 2-star measures. Improving a measure from 1 to 3 stars is generally much easier than improving a measure from 3 to 4 stars. This aids Improvement measure success and can be more than eight times more impactful on the Reward Factor.
• Double-down on data. Stars is, and has always been, a data game. Make sure you have Healthcare Effectiveness Data and Information Set (HEDIS) and Part D measure data in the same location where you store members’ self-reported Consumer Assessment of Healthcare Providers and Systems (CAHPS), HOS and Health Risk Assessment (HRA) data. Then use this comprehensive data in your Stars dashboards and analytics. Plans must analyze to properly prioritize!
• Double-down on members in need. Members who respond negatively to CAHPS are often the ones that respond negatively to HOS and many of them will be evaluated by 2024 Health Equity Index. While it can be tempting to try to convince the member to think differently, it is actually much easier, faster and more successful to truly help them. The reality is that members struggling with CAHPS almost always have unmet needs for appointments, getting medications, or coping with their life and health. Health plan success rests on these members’ success. Ask how you can help and then help. Even small amounts of periodic, Stars-focused engagement can change ratings. Strive for progress, not perfection.

Success in Stars isn’t always about adding new and more work, it’s often about evolving and adapting. Find a few things to stop doing – and stop them! Most plans rarely, if ever, trim and terminate activities from their Stars workplan. Early Q4 is a great time to make sure that every tactic and expenditure is reaching the members and providers you most need to impact for 2023 and 2024 Star Ratings success.

While we await CMS releasing the next Final Rule with details on the many pending proposals for 2025 that CMS delayed decisions on earlier this year, regulators have dramatically increased their attention and focus on Medicare Advantage. Among other hot topics, Congress is spending their fall focused on Pharmacy Benefit Managers and pricing transparency, sales and marketing oversight, prior authorizations and risk adjustment, and more.

We know how hard it is to succeed in Stars amidst an era of change, when decisions must be made with no safety net and when both the risks and stakes of decisions are high. If you need help, call us. We love helping plans achieve and sustain strong ratings. Email me at melissa.smith@healthmine.com for more information.