CMS Proposes Several Key Changes for Star Ratings in 2018 Medicare Advantage (MA) Draft Call Letter

The potential changes to the Star Ratings program announced by the Centers for Medicare & Medicaid Services (CMS) last week in the annual Advance Notice may look minor at first glance but are sending shock waves through Star Ratings teams this week. Although most changes proposed for the 2018 Star Ratings (for which measurement periods are generally already complete) are unsurprising, CMS has proposed several key changes worthy of feedback during the comment period:

  • CMS is looking for measures where performance has “topped out” to transition to the Display Page as new measures are added in 2017, with specific mention of the Diabetes Care – Kidney Disease Monitoring measure. Combined with the National Committee for Quality Assurance’s (NCQA’s) public comment period regarding potential removal of the Diabetes Care – Kidney Disease Monitoring and Adult BMI Assessment measures from health plan accreditation scoring in 2018, plans who count on these relatively easy process measures to offset lower performance on more challenging measures should be prepared for the impact future removal of these measures may have on their overall rating.
  • CMS requests feedback regarding potential cross-cutting exclusions for members with advanced illnesses (such as those who are in, or should be in, palliative care programs), which could dramatically increase alignment of Star Ratings with holistic, person-centered care. Plans should consider how their Member Experience could be improved if such cross-cutting exclusions were incorporated within Star Ratings and provide feedback to CMS accordingly.
  • Numerous changes with important implications are proposed for the 2019 ratings (for which 10% of the measurement period is already complete!). Several silo-busting measures with important operational and analytics implications are proposed for addition, and CMS has also proposed triple-weighting the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Care Coordination and Medication Reconciliation Post-Discharge measures as leading proxies for a growing foundation for well-integrated, person-centered care that creates a positive experience for members.

Looking at and beyond the 2019 changes, CMS is focusing on important areas which are not rapidly or easily influenced and which require carefully designed, often sequential, interventions with patients and providers (inpatient and outpatient) for success. Although the asthma and depression measures look likely to be delayed until after the 2019 ratings, a long and cross-functional runway is needed for success on potential new 2019 and 2020 measures. However, because these measures can serve as proxies for high-quality care that improves health outcomes and can potentially improve medical trend, these future new measures are worthy of near-term activity.

All of these proposed changes require a cohesive strategy, supplemented by the right activities deployed through the right channel at the right time, to achieve strong Star Ratings. Our team of experts can help you develop or enhance your Star Ratings work plan, your provider engagement strategy, or your member engagement strategy to incorporate CMS’ new Star Ratings proposals.   For questions or additional information about how Gorman Health Group can support your Star Ratings needs, please contact me directly at msmith@gormanhealthgroup.com.

 

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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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