2021 Star Ratings First Plan Preview

The Star Ratings Plan Preview periods are officially underway, and like everything else in 2020, this year’s efforts will be different and unprecedented.

Not only do the 2021 Star Ratings mark the first of several years of significant changes to CMS’ measures and program criteria, but these ratings also reflect very unusual, unexpected policy accommodations for the early impacts of COVID-19.

The most noteworthy changes implemented during the First Plan Preview include the following:

These high-impact changes will likely garner the most attention in the next few weeks, but don’t forget some other important changes implemented for the 2021 ratings:

  • Adoption of revised Part C Appeals Timeliness measure (which now includes cases dismissed by the IRE because the plan subsequently approved coverage/payment).
  • 2021 Improvement measure scores based on HEDIS and CAHPS data use the earlier values comparing 2020 ratings data to 2019 ratings data.

As we enter what many scientific and medical experts believe to be the final lull before our once-in-a-lifetime Coronavirus/Influenza fall and winter seasons begin, it’s more important than ever before to start late-year “Stars hail Mary” efforts as early as possible. 

Many plans are flooding members’ homes with in-home testing kits, using telehealth creatively to close clinical gaps in care, and resourcefully bolstering member experiences before they become 4x weighted in January 2021. All of these efforts must be tightly focused on the new path which accounts for even more measure additions, removals, and changes than those announced above.

Conclusion

It has never been more important to rapidly deploy expert, competitive tactics to earn or stay at 4 stars. If you need assistance, GHG can help. Contact me at msmith@gormanhealthgroup.com for more information.

Melissa Smith
Melissa Smith

Melissa Smith is Senior Vice President of Stars & Strategy at Gorman Health Group, LLC (GHG). Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports our clients’ strategic planning needs.

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