Jump Starting Stars Success and Innovation

The Centers for Medicare & Medicaid Services (CMS) imposed several challenges for Medicare Advantage plans hoping to pave a path to four or more Star Ratings in 2023, but Measurement Year (MY) 2024 is the true test of plan performance and interoperability. As plans map out their mid-year initiatives to ensure Star Rating success before the end of 2023, this time of year is the perfect opportunity to bolster strategies to address the many changes on the horizon.

In a recent webinar, Healthmine Expert Advisory Services team broke down the big roadblocks to Star Ratings success in MY2024 and highlighted short- and long-term strategies to overcome them. Speakers included:

• Melissa Smith, Chief Consulting Officer, Consulting & Professional Services
• Cynthia Pawley-Martin, Senior Advisor, Consulting & Professional Services
• Cherie Shortridge, Senior Advisor, Consulting & Professional Services

Moderated by Kent Holdcroft, Chief Growth Officer, this webinar guided plans through a high-level view of major measure changes and new regulations, including the Tukey Outliner Deletion Model, Health Equity Index and digital quality measures. The big takeaway: there are no magic tricks to success, and plans will need to think strategically about how they solve problems to safeguard continuous improvements.

Watch the on-demand webinar and access the presentation slides to bolster your Star Ratings workplan with innovative tactics for adapting to the future of Medicare Advantage quality improvement.

Measure Changes from a Birds-Eye View

MY2024 kicks off the start of several game changing regulations, compliance standards and measure updates. Melissa trimmed down the extensive list of changes tucked away in the 2024 Final Rule to highlight the top priorities for Medicare Advantage and Part D plans, including:

New measures

• Improving and maintaining physical health
• Improving and maintaining mental health
• Kidney health for patient with diabetes

Measure changes

• Reducing CAHPS and administrative measure weights to 2x
• Transitioning colorectal cancer screenings from a hybrid measure to Electronic Clinical Data Systems
• Using continuous enrollment data do monitor Prescription Drug Events
• Removing the 15-minute wait time question from the CAHPS® survey

Program Changes

• Measuring Health Equity Index performance with MY2024 and MY2025 data to inform the 2027 Star Ratings
• Incorporating web surveys for CAHPS starting with the MY2024 Survey for the 2025 Star Ratings

Prepare for Star Ratings Suppressions

CMS finalized the use of the Tukey Outlier Deletion Method for calculating Star Ratings cut points starting with the 2024 Star Ratings. Using MY2022 measure performance, CMS will shave off both high and low scores that rank outside the mean. Plans on the border of the next Stars level could be pushed just below the threshold and lose their changes at securing four or more Stars.

Melissa provided real-world projections to help plans understand the mathematical impact of Tukey on Stars performance and encourages plans to incorporate CMS’ projection models into their analytics to avoid any surprises.

The Race to Health Equity Starts in MY2024

The addition of the Health Equity Index (HEI) incentivizes Medicare Advantage and Part D plans to improve health outcomes for members with specific social risk factors (SRFs), including low income subsidy (LIS), dual-eligible (DE) and disabled members.

Cherie guided plans through the intricacies of the HEI, including how plans can:

• Determine if their contracts are eligible for rewards under the Health Equity Index and if they meet the minimum thresholds for SRFs enrollment and quality scores
• Identify LIS, DE and disabled members within current populations
• Detect inequities in care by comparing health outcomes between members with SRFs and members without SRFs
• Calculate their HEI scores and rewards

Brainstorm Short- and Long-term Solutions for Digital Quality Measures

Sustaining four or five Stars Ratings requires immediate action to address the transition to digital quality measures, but there is still time to safeguard Stars success.

In a deep dive on all things digital quality, Cynthia provided plans with:

• Clear definitions of Electronic Clinical Data Systems (ECDS), digital quality measures (dQMs) and Electronic Clinical Quality Measures
• Short- and mid-term strategies to address ECDS while laying the groundwork for long-term digital interoperability
• Insight into which data sources plans can tap into to meet dQM requirements
• Strategies for collecting dQM data now through self-attestation, chart chasing, record updates and provider engagement

Address Foundational Changes Across All Markets

While there are significant changes occurring within the Medicare Advantage marketplace, most of these changes do not exist in a vacuum. Dual-eligible Special Needs Plans, Medicaid and Affordable Care Act plans must also adapt their own strategies to address health equity, dQMs, interoperability, medical costs and new quality requirements.

Melissa urges plans to think beyond individual contract solutions to brainstorm market-wide strategies that move an organization forward across multiple pain points. The nuances of each market’s quality programs will require targeted solutions, but plans should not lose sight of the wide-spread changes. Instead, plans should focus on identifying opportunities to improve interoperability and address multiple challenges with one solution.

Your Pain Points are Universal

Our Expert Advisory Team presented an extensive list of common challenges Medicare Advantage plans are facing in 2023. From the return of the Health Outcomes Survey to changes to risk adjustment methodologies, large and small plans alike are feeling the impact of CMS’s new regulations. In addition to showing plans that they are not alone in their struggles, the team also urged them to budget time to identify these problems within their own organization. Plans cannot between thinking tactically about their Star Ratings unless they first understand the problems their trying to solve.

To close out the webinar, the speakers provided answers to the biggest questions and problems plans are contending with, including:

• What is the current status of the second part of the 2024 Final Rule?
• Which measures will CMS focus on for the Health Equity Index?
• How can plans address Star changes for Institutional Special Needs Plans and Dual-Eligible Special Needs Plans?
• Will CMS implement a Stars-like program for Medicaid Managed Care?
• How can plans improve access to care through in-home care and telehealth services?
• How do plans develop a better understanding of barriers to care and social determinants of health at a member level?
• How can plans improve self-attestation to identify race, ethnicity and language preferences?

Get answers these questions and more by completing the form and watching the full on-demand webinar.