Part D Plans Fare the Worst in 2019 Star Ratings

By Judy Packer-Tursman 

CMS painted a rosy picture when it unveiled Medicare star ratings on Oct. 10, saying that, in 2019, most regions across the U.S. will have Medicare Advantage (MA) and Part D plans with 4 or more stars — the rating needed to qualify for a 5% federal quality bonus, which is seen as a critical competitive advantage. In the aggregate, the percentage of beneficiaries covered by plans qualifying for bonuses is edging slightly upward, CMS also reported. Individual plan performance runs the gamut, and an initial review of publicly traded insurers reveals ratings “winners” this year led by Centene Corp., and “losers” including Anthem Inc., Wall Street analysts say.

Yet an industry expert offers a different take from the financial analysts on a couple of issues, first telling AIS Health that it’s important to look at how stand-alone Prescription Drug Plans (PDPs) fared in this latest iteration of star ratings — a 5-star system established by CMS in 2007 that measures an array of clinical quality and beneficiary experience areas. In 2012, ratings became tied to bonus payments.

“At an industry level, there are two big findings. There wasn’t really that much change in star ratings, particularly for MA-PD,” says Sean Creighton, vice president in the policy practice at Avalere Health, referring to MA plans that offer drug benefits. “However, there was quite a decrease in the ratings for stand-alone PDPs….I’m sure the Part D plans would love to have their scores improving instead of decreasing, but it wasn’t a good year in terms of quality improvement for Part D plans.”

Of 13 ongoing quality measures on the Part D side, PDPs’ performance fell on eight measures and increased on only three measures year over year, Creighton says. For example, he points to PDPs’ performance on medication adherence for diabetes, which dropped from 3.2 stars to 2.6 stars in the aggregate, he says. By contrast, MA-PDs’ rating on the same measure improved from 3.3 stars to 3.7 stars in the aggregate.

From Health Plan Weekly

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