Beneath High Ratings, MA-PD Stars Scores Show Shortcomings

by Lauren Flynn Kelly

Thanks to numerous flexibilities granted to plan sponsors during the COVID-19 public health emergency, nearly 70% of Medicare Advantage Prescription Drug (MA-PD) plans earned an overall rating of 4 stars or higher for 2022, CMS said on Oct. 8. That's compared with just 49% of MA-PD plans in 2021.

According to the CMS fact sheet released alongside the stars data, the average MA-PD star rating weighted by enrollment improved from 4.06 in 2021 to 4.37 for 2022. Weighted by enrollment, approximately 90% of MA-PD members are currently in contracts that will have 4 or more stars in 2022, CMS estimated.

CMS adjusted measures due to pandemic:

• "[T]hose of us who eat, sleep and breathe stars believe this is a one-year anomaly," remarks Melissa Smith, executive vice president, consulting and professional services, at HealthMine, Inc. That's in part because, given the extraordinary circumstances of the COVID-19 pandemic, CMS in 2020 suspended the collection of Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data that would have impacted the 2021 star ratings and instead used the data from the prior year to calculate those ratings.
• CMS also allowed plans to use the better of the two years' rating (2021 or 2022) for most measures because all contracts qualified for the "extreme and uncontrollable circumstances policy."
• On top of the COVID-related adjustments for 2022, CMS at the last minute removed two triple-weighted Health Outcomes Survey measures — Improving or Maintaining Physical Health and Improving or Maintaining Mental Health — which also boosted the ratings, points out Smith.

Plans should brace for tougher 2023:

• "The underlying data shows an awful lot of weakness and erosion in performance that is masked by the COVID relief in the actual ratings," asserts Smith. According to a CMS table displaying the average Part C measure scores prior to the disaster adjustments, plans performed worse on 16 out of 27 measures compared with the prior measurement year.
• In the next couple years, the star ratings program will become significantly harder, says Jessica Assefa, senior director of star ratings with GHG Advisors. Controlling Blood Pressure and Plan All-Cause Readmissions will return from the display page, and CMS will adopt some complex changes to HEDIS metrics. In addition, member experience measures based on CAHPS and administrative data will move from a weight of 2 to 4 starting with the 2023 ratings.

From RADAR on Medicare Advantage