New Year, New Star Ratings Measures

As we near the end of the first quarter, most of us have recovered from the now-annual “4th quarter Stars fire drill” and finished onboarding new members. There is no rest for the weary in Star Ratings, and it’s time to get focused on some of the issues and measures not easily tackled during busier times of the year.

Calendar Year 2018 is the second measurement year in which plans will be rated on the new statin therapy measures, and plans are focusing efforts on these interrelated measures that will require physician involvement to influence. These measures present some interesting challenges since:

  • Most plans continue struggling to influence providers’ prescribing habits,
  • Most plans continue to work in silos, with Part C Healthcare Effectiveness Data and Information Set (HEDIS®) measures generally supported by Clinical and Provider Relations teams, while Part D Prescription Drug Event (PDE) measures are generally addressed by the Pharmacy team,
  • The volume of members in the denominators for these measures is generally large,
  • Many members will be in both measure denominators, and
  • Compliance criteria differs between the measures.

To help you jumpstart your 2018 action planning for these measures, we thought a quick review of these measures may be helpful:

Statin Therapy for Patients with Cardiovascular Disease (SPC; Part C HEDIS® measure)

  • Measures the number of males aged 21-75 and females aged 40-75 identified as having atherosclerotic cardiovascular disease who were dispensed at least one high or moderate statin medication during the year and remained on the statin at least 80% of the time.
  • A few interesting points to note regarding this measure:
    • This measure may appear, on the surface, to be similar to SUPD, but compliance requires the statin dispensed to be a moderate to high intensity statin, and the SPC measure also includes an adherence component.
    • Members can be identified by diagnoses (inpatient or outpatient) or event.
    • Measure is based on two years of continuous enrollment.

Statin Use in Persons with Diabetes (SUPD; Part D PDE measure)

  • Measures the percent of members aged 40-75 who were dispensed at least two diabetes medications and who also received a statin fill.
  • A few interesting points to note regarding this measure:
    • Unlike the SPC measure, patients with muscular pain and diseases (e.g., myalgia, myositis, and rhabdomyolysis) are not excluded from measurement.
    • Because denominator criteria requires two fills of a diabetes medication, and members with gaps in this measure, which are created by oral diabetes medications will, by definition, be in the Diabetes Medication Adherence denominator. And when they fill the statin twice, they will also be in the Statin Medication Adherence Denominator.
    • The Centers for Medicare & Medicaid Services (CMS) has signaled its intent to increase the weighting of this measure to 3x, potentially based on the 2018 measurement year.
    • Measure is based on one year of continuous enrollment.

While you’re expanding your work plan to improve performance on these new measures, don’t forget the first quarter of a new measurement year often presents the best opportunity to support the complex clinical needs and social determinants of health of members who struggled last year on heavily-weighted measures. For example:

  • Members non-compliant on the HEDIS® Diabetes Care – Blood Sugar Controlled measure last year due to lack of an A1c screening: It’s important to understand whether these members struggled to access routine care or whether their providers simply failed to submit lab data. Whether through transportation, appointment setting, or coaching, these members may need a little extra help to take the next step – and if these gaps were administrative in nature, obtaining and using data may require more time than may be expected to resolve.
  • Members whose last A1c test result in 2017 was >9: These members may be struggling to manage their condition or facing challenging social determinants of health. Either way, these members may need some support and encouragement to make good diet, exercise, and lifestyle choices, or they may be struggling with medication adherence. The earlier in the year we engage these members so we can identify their barriers and support their needs, the more likely we can help them make the needed changes early enough for the changes to manifest in lower A1c levels before the end of 2018.
  • Members who were very non-adherent in 2017: These members may be struggling with one or more of the many challenges preventing adherence to medication regimens. Many of these members are often in multiple 3x-weighted medication adherence denominators, increasing the value of high-touch interventions. Engaging with these members early in the year to understand and resolve their barriers, and planning for ongoing support through the remainder of the year, can serve as a foundation to these three heavily-weighted measures.

Our experts can help you develop or enhance your 2018 Star Ratings work plan, provider engagement strategy, or member engagement strategy. For questions or additional information about how Gorman Health Group can support your Star Ratings efforts, please contact me at

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!



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.

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
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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