First Plan Preview of 2019 Star Ratings Data

It’s official – the Star Ratings “busy season” is underway! As is always the case, the Centers for Medicare & Medicaid Services (CMS) is allowing a very short review window during the first plan preview period, with all feedback due by THIS FRIDAY, August 17 – so time is of the essence!

As CMS has been promising, there are no surprises in the draft technical notes. The changes as described in the 2019 Call Letter will be implemented as described. This includes:

  • Addition of Statin Therapy for Patients with Cardiovascular Disease (HEDIS SPC) measure
  • Addition of Statin Use in Persons with Diabetes (PQA SUPD) measure
  • Removal of Beneficiary Access and Performance Problems (BAPP) measure

CMS also affirmed several noteworthy measure changes:

  • Implementation of scaled reductions to all Part C and Part D Appeals measures
  • Addition of five measures to Quality Improvement measure calculation (both the Part C and Part D measures)
  • Removal of beneficiaries with ESRD from all Medication Adherence measures, and change to treatment of discharge date in measure calculations

Further, CMS also confirmed several noteworthy program changes:

  • Policy for Star Ratings adjustments impacted by national disasters
  • Removal of numeric scores for certain contracts affected by natural disasters from clustering algorithms

What else should plans do now?

  • Validate your measure rates. Communicate any errors, inaccuracies, or concerns about the rates – or data used to calculate the rates – to CMS by Friday’s deadline.
  • Provide feedback to CMS on the changes announced in the draft technical notes.
  • Get to work! There are only 135 business days remaining in 2018 for you to connect your members with the care and services they need for strong Star Ratings. Every remaining day of 2018 matters to your 2020 ratings!
  • Prepare to receive your draft 2019 rating during Plan Preview #2 in early September.
  • Prepare for the 2019 Star Ratings to go live on October 10.

Improving performance is always challenging, particularly in our current competitive environment. Whether you need help improving current measures or preparing for CMS’ impending increased weighting of Member Access and Experience measures to 2x weights in January, we can help. For questions or inquiries, please contact me 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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