The 2019 Final Call Letter: Stability & No Unexpected Surprises in Star Ratings

The Centers for Medicare & Medicaid Services (CMS) Star Ratings updates in the 2019 Final Call Letter offer a true gift to Medicare Advantage (MA) plans. No significant changes were introduced from the changes previously announced in the Advance Notice, with the interesting surprise CMS still has not removed any of the “topped out” measures or made changes intended to support Administrator Verma’s Patients Over Paperwork or Meaningful Measures vision. Assuming no surprises are introduced when the technical notes are released, CMS provides MA plans with the gift of stability and no unexpected surprises in Star Ratings.

This stability, combined with CMS’ affirmation it will expand the definition of health-related supplemental benefits, offers industry leaders a stellar opportunity to dig deep in 2019 to re-envision the member experience, care management, and member support functions in preparation for inevitable program evolution.

With CMS’ far broader definition of the term “supplemental benefits” to include services that represent daily maintenance, CMS will for the first time allow plans incredible flexibility to support members in ways that resolve some of the many barriers to care that have historically prevented Star Ratings success. Early adopters will undoubtedly consider adding benefits such as non-skilled in-home care, routine delivery of meals and/or healthy foods, air conditioners for people with asthma, simple home modifications, and other personal care needed to support activities of daily living – all of which will positively impact many of the challenging, heavily-weighted outcomes measures. Because plans will be able to customize supplemental benefit offerings to support their members’ unique combination of social determinants of health, this new provision should reward early adopters with the opportunity to bend cut point trends.

It is important to note CMS’ reiterated plans to establish a Technical Expert Panel (TEP) in 2018, comprised of representatives across stakeholder groups to obtain feedback on the Star Ratings framework, topic areas, methodology, and operational measures. Careful attention should be paid to the work of this TEP as it will likely serve as CMS’ sounding board for program changes, which are now long overdue.

Need more Insight? Don’t miss our Star Rating’s workshop at the Gorman Health Group 2018 Forum where we’ll review the technical construct of the Star Ratings program. From measure specifications to financial impacts, we’ll cover the full spectrum of technical aspects. Download our preliminary agenda and register today!

For more information regarding the impact of the Call Letter on your organization, contact me today at msmith@gormanhealthgroup.com.

 

 

Resources:

Gorman Health Group’s summary and analysis of the 2019 Advance Notice and Draft Call Letter for Medicare Advantage and Part D is now available. Download now

Registration is open for the Gorman Health Group 2018 Forum, April 25-26, 2018, at the Red Rock Resort ideally located near the Red Rock Canyon in Las Vegas. Download our agenda here.

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Melissa Smith
Melissa Smith

Melissa Smith is Senior Vice President of Sales, Marketing, Strategy and Stars 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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