6 min read

Impact and response: Changes in Medicare Stars for 2023 and beyond

Impact and response: Changes in Medicare Stars for 2023 and beyond

by Jeff Cox

With my focus on risk adjustment and quality here at Belong Health, I often find myself immersed in the data end of the pool — intensely focused on measurements of how well and how often our members are interacting with their primary care providers (PCP) and other clinical resources. 

Are they getting their preventative screenings? Are they managing their chronic conditions? Do they have the regular support they need? 

The answers to these kinds of questions translate into important facts and figures, sure, but I never forget they’re always tied to personal stories, too. To needs, fears, triumphs, and relief. 

To a family like my own. 

My dad is a 77-year-old prostate cancer survivor. As might be expected, he often looks to me to help make sense of his medical needs. Simultaneously, he keeps me mindful that everyone deserves someone who can help simplify the complex

So, in the same spirit of those dinner table chats with my dad, I’m eager to be of help to you, as all of us in healthcare brace for complex changes in the year ahead — including a new methodology for the Star ratings system.

Realignment of the Stars

First, some background. 

In 2020, prompted by the COVID-19 pandemic and by an era in which fewer people were visiting with their PCP, the Centers for Medicare and Medicaid Services (CMS) implemented a disaster provision that fundamentally changed the ways in which Star scores were assessed. Beginning that year, plans were allowed to select the best of their own scores, including those that had been awarded during a range of pre-COVID years, as indicators of their current performance.  

Because of this methodology, however, an overall inflation of resulting Star scores yielded historically high ratings across the industry. Where typically only 25% of contracts increased each year, the year 2022 (which reflected the 2020 performance year) saw a staggering 62% of contracts enjoy such a performance boost. 

In response to this unprecedented boom, CMS officials determined changes to the evaluative process were necessary. They elected to tweak that landscape towards what they believed to yield clearer, fairer assessment.  

As a result, four key adjustments are already underway — and they’ll each have big impacts on Star ratings in 2024 and beyond. 

  • The disaster provision implemented in 2020 has been allowed to expire. Plans can now no longer leverage the “better of” methodology to inform their overall scores. 
  • Patient experience measures (a key component in Star assessment) have doubled in weight, from 2X to 4X. This change, likely implemented to champion a focus on people over process, will deliver varying degrees of impact on Medicare Advantage organizations. 
  • CMS “cut-point guardrails” are now in place. These parameters impose clear limits on how much a cut-point can change, year after year. In the past, for example, a plan which once needed 15% of its members screened for colorectal cancer in order to achieve a 3-star rating might have, the following year, suddenly needed 65% of its members screened in order to secure the same Star result. For 2024, however, CMS is clamping down on those wild swings in percentages. 
  • The Tukey Outlier Deletion Method, resulting from a statistical modeling change, will be implemented in Star rating year 2024, to reflect the 2022 performance year. With the help of this new method, seemingly higher-performing plans will no longer be “propped up” by lower-performing outlier plans. 

All told, this collection of scoring adjustments already points to an upcoming 3% change in cut-points for four-and-a-half star ratings. In other words, relative to recent years, it will soon be more difficult for plans to secure a 4-Star or better rating. This will have significant impacts to Quality Bonus payments and the potential for year-round enrollment.

What This Means For You 

These changes may seem like a lot for a health plan to manage. 

Plans that can’t maintain high Star ratings — or can’t quickly rebound their performance — risk all manner of reduced Medicare bonuses and rebates.  

Of course, there are marketing consequences, too. On the CMS website, Star ratings are prioritized for beneficiaries, heavily informing their plan selection process. A reduced Star score will certainly be difficult for potential beneficiaries to ignore. 

Simultaneously, more challenging parameters for cut points could drive $800 million in annual revenue impact as we reach 2024. Contracts with 3.5-4.0 ratings are likely to be the hardest hit. 

Needless to say, in the months and years ahead, blunting the negative impact of these changes will be of increased importance for plans across the country. Diagnostic analyses and targeted initiatives — especially those concerning member experience, as it is excluded from guardrail provisions — will be central to a plan’s success. 

Belong is Built for This 

Even in light of all of this change and uncertainty, I can’t help but be optimistic about the new quality landscape. After all, the various adjustments implemented by CMS only play into Belong’s strengths. 

Our general care management model, as just one example, has always prioritized member experience — the very same Star measures that have now doubled in weight

Belong’s experts live in and love the very communities they serve. And, as our work centers people with a range of complex health needs, we’re fueled by frequent, informed, and compassionate interactions with each and every member.  

We oversee health risk assessment (HRA) completion with a deep sense of investment, and we dive into the weeds with each member to help explain their treatment options in grounded, community-specific language. That’s just how we do our work. 

Simultaneously, we equip members with greater mastery over their care process in ways that, over time, are primed to redefine the context of caretaking and provider engagement. 

All told, that sort of member-focused sensitivity — that whole-person care — is exactly why we opened our doors in the first place. It’s our key differentiator. 

And now quality is truly our competitive advantage.  

A Bright Future  

Transition of care. Telehealth options. Preventative services. Medication adherence. Trusted patient engagement. 

All will be crucial to Star success stories in 2024. All are already deeply woven into the difference Belong Health makes every day. 

So, as plans across the country reflect on their own work of the past few years, as they assess why they may have been relying on selecting the “better of” scores in the first place, I hope they pause to consider the member-focused model that already fuels Belong Health’s own success. 

Because every day, as we regularly follow up with patients with chronic conditions, as we check in after emergency department visits, as we schedule members for colonoscopies or cancer screenings or other HRA-related considerations — as we gently guide members to fuller ownership of their own health and capability, I’m deeply grateful for the impact of this work. 

And, yeah, I’m deeply grateful for my dad. 

Because I can’t help but think of how many people like him — how many families and loved ones — are treated as data, rather than as human beings. How many people with complex needs are left to fend for themselves against confusing medications and suffocating expenses, without the guidance of someone who knows and cares about the unique realities of their lives. 

After more than a decade of professional experience in the healthcare space, I know there’s truly no substitute for the grounded, personal touch of a knowledgeable family member or friend who won’t let a detail slide by unnoticed. 

That’s exactly the measure of care where Belong Health excels. It’s the kind of care every person — and family — deserves. 

And I have no doubt it will drive vital differentiation in the new Star landscape we’re all about to traverse together. 

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