2021 Star Ratings Second Plan Preview

Perhaps one of the most exciting, and worrisome, weeks of the entire year for Stars teams across the nation is here – and it comes with enormous financial consequences. The Second Plan Preview has officially been released and, just as everything in 2020 has been, this year’s Star Ratings will be unlike anything we’ve ever seen in Stars before. 

Here are some quick highlights from the 2021 ratings:

  • In accordance with the COVID-19 relief announced in the IFC earlier this year, all HEDIS and CAHPS measures received their 2020 measure ratings. This caused 23 of the 44 measures being rated to have been carried over from last year, representing almost 40% of the overall Star Rating.
  • The Medication Adherence and SUPD measures, which comprise 15% of the overall rating, all continued seeing improvements, as demonstrated by increases in 15 of the 16 cutpoints on these triple-weighted measures. The cutpoint increases are surprising in light of the negligible changes in national average on these measures – and continued evidence of the challenges predicting cutpoints.
  • As expected, all Member Experience measure weights increased to 2x (including CAHPS and Administrative measures) and the SUPD measure increased to 3x.
  • Among newly-calculated 4-star cutpoints, there was a pretty even mix of measures where the “magical 4-star cutpoint” increased versus decreased.
  • Pursuant to a separate announcement from CMS this week, the HOS survey administration timeline has been permanently adjusted and surveys will continue to be performed between August and November going forward.

Regardless of whether you are celebrating your 4+ star overall rating or are worried that you’re still not doing enough to earn the elusive 4th star, every day and every decision matters during the remaining days of 2020.

And amidst the pandemic where our seniors and younger disabled members are, with good reason, more hesitant than normal about seeking normal clinical care, it’s time for us to get creative for an “unprecedented” 4th quarter press. 

Here are a few tips:

  • Identify your 2022 Star Ratings COVID relief. CMS has announced the COVID relief for the 2022 Star Ratings, and plans with more than 25% of their members in affected areas (which includes most plans) will be eligible to receive the better of their actual 2021 rating or earned 2022 rating for the 2022 ratings cycle (at the measure level, for non CAHPS measures). While we are strong proponents of every measure mattering, and always having a plan B, CMS giving us advance notice of this relief does allow plans to relax some efforts in areas where their 2021 ratings are already at 4 or 5 stars and focus in underperforming areas.
  • Confirm investment allocations. Time and money are our most precious resources, and the “math path” for Stars success changes again (dramatically!) on January 1. Review your 4th quarter workplan and budget to make sure you are spending both time and money where your contract’s measure math shows you it’s needed. Allow colleagues to speak up about initiatives that are low impact and not likely to produce results so they can be stopped – don’t waste time, money or effort on activities that are not accomplishing Star goals.
  • Don’t forget to use your Spring 2020 CAHPS and HEDIS data. Even though this spring’s CAHPS and HEDIS measure rates were not in these ratings, make sure they are socialized and used for 4th quarter and 2021 Stars workplanning. If your spring 2020 rates were better than CMS used for the 2021 ratings, socialize that among leadership to ensure leaders can celebrate the hard work done in your organization. If your spring 2020 rates were worse than those used in the 2021 ratings, that needs to be vocalized as well so that existing problems aren’t masked by the COVID relief granted by CMS.
  • Ask the right members and providers for exactly what you need. Integrate your data to identify the full picture of your “ask” of a member or provider and prioritize your request to avoid overwhelming them. Collaborate across departments to make sure your members and providers aren’t receiving conflicting or confusing messages.  
  • Don’t forget the importance of complete data. The changes made this year to HEDIS measures allow many more appropriate exclusions (though some can only be created through administrative data – which means qualifying members may still need an appointment before year end), and greater allowance of telehealth to support Star needs. Identify a staff person to quickly mine your data to find members who likely meet exclusionary criteria and schedule them for an additional visit this year and/or ensure all codes submitted by providers are properly loading into your HEDIS tool.   

Whether you need help developing a data-driven Star Ratings workplan or improving your organization’s Star Ratings, GHG has the expertise to help. Contact us to learn more. 

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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