Plethora of ‘Granular’ Changes Will Drive Medicare Advantage Orgs’ Stars Strategy

by Lauren Flynn Kelly

With continued emphasis on member experience, several new Part C measures and a directional shift to closing health care inequities, 2022 stands to be a landmark year in terms of changes to Medicare Advantage organizations’ star ratings strategies, industry experts tell AIS Health. 

Small changes could sneak up on payers 

• “There is so much earth-shattering change on the horizon that most plans are just not thinking about,” cautions Melissa Newton Smith, executive vice president, consulting and professional services with Healthmine, Inc.  
• The 2022 measurement year brings an unprecedented amount of change “at a detailed, granular level” that will require a major shift in plans’ star ratings approaches, observes Smith. 
• Changes include the addition of two new measures — Transitions of Care and Follow-Up After ED Visit for People with High-Risk Multiple Chronic Conditions — the return of Plan All-Cause Readmissions, and an increased weighting for Controlling Blood Pressure. 
• Moreover, this is the second measurement year in which the patient experience measures — i.e., those based on Consumer Assessment of Healthcare Providers and Systems (CAHPS) and CMS administrative data — will have an increased weighting of 4, up from a value of 2 in 2020.  
• “This shift in weightings is also consistent with what the plans are trying to achieve in terms of member retention and member engagement, so they’re already seeing that they need to start being more proactive in the way they engage members starting at the point of sale,” remarks Cary Badger, principal with HealthScape Advisors LLC. 

New R&I rules pose additional challenges 

• Complicating all of these efforts are changes to the definition of “qualifying individuals” in rewards and incentives programs that mean plans can no longer rely on HEDIS denominator and/or numerator status to target R&I participants and improve related star measures. Those changes took effect on Jan. 1, and noncompliance can result in sanctions, CMS clarified in a January 2021 rule. 
• “People at health plans have a lot of competing priorities, stars being a high priority, and there has been an overwhelming preponderance of plans in MA that created these programs with a fairly narrowly appointed group of activities that focus on stars,” explains Smith. 
• “Given the robust adoption of rewards programs in MA in recent years, this type of clarity was inevitable,” she continues. “CMS had to get clearer from a beneficiary protection standpoint to ensure that rewards programs continue to serve their purpose of motivating desirable health behaviors while stopping short of being cash inducements — either to enroll or remain with a plan and/or to respond to member experience surveys positively. It’s a fine line, and one which we expect to see dramatically evolve in 2022 and 2023 as plans react to the clarity.” 

From Radar on Medicare Advantage