Melissa Smith

2018 Star Ratings Offer Valuable Insight into Competitive MA Industry

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The Centers for Medicare & Medicaid Services (CMS) release yesterday of the 2018 Star Ratings offers valuable insights into the significantly competitive Medicare Advantage (MA) industry. Here are just a few early observations and some insight into why it’s important:

  • Though the number of contracts at 4+ stars decreased from 49% in 2017 to 44% in 2018, the number of members in 4+ star contracts increased from 69% in 2017 to 73% in 2018. For beneficiaries, this is excellent news as this means most beneficiaries will be enrolled in plans that are able to leverage quality bonuses to provide members with improved benefits and services, reduced costs, and stronger customer service.
  • Cut points for many measures increased in 2018, some dramatically. After a couple of years without many significant cut point changes, the 2018 ratings include many cut point increases. In many cases, the national average on these measures remained unchanged. The 2018 cut points offer a harsh reminder Star Ratings require relentless pursuit of success.
  • Only 17% of plans in MA less than 5 years earned 4 or more stars. Most new entrants count on earning quality bonuses without investing the precise, nuanced rigor needed to earn 4 or more stars. For plans new to MA, these headwinds are significant and require commitment to overcome.
  • Of the 6 plans that earned 5 stars for the first time in 2017, only 3 maintained their 5-star rating in 2018. Achieving 5 stars requires a long-term, consistent corporate commitment to excellence – clinically, operationally, and culturally. For plans new to this elite achievement, it sometimes also requires a bit of luck while this trifecta of excellence is perfected.
  • No plans received the Low Performing Icon (LPI) in 2018. Though CMS no longer terminates plans based upon continued poor Star Ratings, it is a positive sign no plans are lingering below 3 stars for 3 or more years.

Whether you need help developing a data-driven Star Ratings work plan or improving your organization’s Star Ratings, we can help. Contact me at msmith@gormanhealthgroup.com to learn how we can help.

Join us for a free webinar on Wednesday, October 25, from 1-2 pm ET, as John Gorman and I provide an in-depth look at the trends of the 2018 Star Ratings and their implications for your organization. We will take a look at national performance trends, discuss changes within the cut points, and share suggestions to prepare for the CMS evolution of the Star Ratings program in 2018 and beyond. Register now >>

 

Resources:

GHG can now efficiently analyze health plan data to pinpoint key areas needing improvement, assess the root causes of these pain points, and deliver a data-driven action plan to increase your ratings. Learn more about our new service >>

Want to stay up to date on policy and regulation changes? The Insider is GHG’s exclusive intelligence briefing, providing in-depth analysis and expert summaries of the most critical legislative and political activities impacting and shaping your organization. Read our full press release >>

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Melissa Smith

About Melissa Smith

Melissa Smith is the Vice President of Stars & Quality Innovations at Gorman Health Group (GHG). She brings more than 20 years of healthcare experience to GHG, more than five of which have been in an operational leadership capacity in Medicare Advantage (MA) and Part D health plans.

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