For Medicare Advantage (MA) plans, HEDIS®-based measures have been the focal point of the Star Ratings program for years. Even as the Centers for Medicare & Medicaid Services (CMS) made changes to the program, strong performance in these measures was essentially a formula to reach a 4-Star Rating.
For many plans, the strategy to improve HEDIS® performance was through multiple campaigns and member touches. While this approach was initially successful, it often meant members would receive multiple mailings throughout the year. In recent years, plans have started to consolidate communications to address all HEDIS® gaps for a member, but the underlying approach is still campaign based.
Recommendations Become Reality
On May 13, our COO, Amy Lung, and Stars Consultant, Rex Wallace, conducted a joint webinar to address the changes to the Star Ratings program because of the COVID-19 global pandemic as well as proposed CMS regulatory changes. One of the key themes was the importance of the member experience. CAHPS and member experience measures officially moved from a weighting of 1.5 to 2.
Although CMS had been publicizing the change in previous Advance Notices, it came as a shock, as the change would be implemented during a year when the CAHPS survey was suddenly halted. Previous CAHPS results included in the 2020 Star Rating will be used for 2021 Star Ratings. Additionally, there has been skepticism that CMS would increase CAHPS and member experience measures to the proposed weight of 4.
Now CMS has made it clear in the 2021 rule changes that member experience measures are moving to a weight of 4.
With this weight change, CAHPS-based measures constitute the greatest percentage of the Star Ratings calculation. CMS has implied that this change will reduce the number of plans earning 4 or more Stars, and this redistribution of Star Ratings results in cost savings of $3.65 billion in quality bonus payments over 10 years, which offsets cost increases from Medical Loss Ratio (MLR) regulations.
Path Forward is a Focus on Member Experience
It is clear through these changes that HEDIS® is no longer the focal point of the Stars program; CAHPS is now king. Plans should evaluate how the 2021 rule changes impact their overall Star Ratings and the resulting financial impact, as well as start planning now for CAHPS-based interventions with a focus on the member experience. Now is the time to switch from campaign-based initiatives to continuous member engagement.