On August 7, the 2021 Star Ratings kicked off with the announcement of the first plan preview. This marks the first time that official performance data on all scored measures are presented in a single report. This year, the Centers for Medicare & Medicaid Services (CMS) is allowing plans two full weeks instead of one week to review data and submit feedback.
As CMS communicated on March 31, previously reported 2019 HEDIS® and CAHPS scores are being used for 2021 ratings and are published again in this plan preview. In addition, the draft technical notes CMS aligns with the information described in the 2021 Call Letter.
Measure Changes to Note
Health plans should pay special attention to the increased weight from 1.5 to 2 for member experience measures.
| Member Experience Measures | |
| Part C Measures | Part D Measures |
| Getting Needed Care | Call Center - Foreign Language and TTY Availability |
| Getting Appointments and Care Quickly | Appeals Auto-Forward |
| Customer Service | Appeals Upheld |
| Rating of Health Care Quality | Complaints About the Drug Plan |
| Rating of Health Plan | Members Choosing to Leave the Plan |
| Care Coordination | Rating of Drug Plan |
| Complaints About the Health Plan | Getting Needed Prescription Drugs |
| Members Choosing to Leave the Plan | |
| Plan Makes Timely Decisions About Appeals | |
| Reviewing Appeals Decisions | |
In addition to the changes to member experience measures, the following changes have been implemented:
- Statin Use in Persons with Diabetes increased from weight of 1 to 3
- Plan All-Cause Readmission is retired for the first year
- Controlling Blood Pressure is retired for the second year
Final Thoughts
Given the short window to provide feedback, plans should validate the accuracy of measure rates immediately. Any concerns about the data provided should be communicated to CMS by 5:00PM Eastern Time on August 17, 2020.
After validating the accuracy of the data, it is important for plans to start end-of-year pushes now. There are four months left in 2020 for plans to impact 2022 Star Ratings.
With the increased weights to member experience measures, a key to success is connecting with each member via their preferred mode of communication to ensure each receives needed care and services. It is critical that plans start preparing for the 2021 plan year; the member experience for that plan year will be weighted at 4 in the 2023 Star Rating.