The Centers for Medicare & Medicaid Services continues to tweak the Stars program. The agency intends for the changes to improve the program, but Kevin Mowll, executive director of the Rise Association, says the shifting areas of emphasis often generate uncertainty. Read on to learn more about the changes planned for the 2019 Star Ratings.

Medicare Advantage Health plans got their first glimpse of 2019 Star Ratings data earlier this month when the Centers for Medicare & Medicaid Services (CMS) opened its first preview period in advance of the Star Ratings go-live date of Oct. 10.

Given the history of CMS changes and tweaks to the Stars program over the years, health plans await these announcements with great anticipation and a little trepidation, says Kevin Mowll, executive director of the RISE Association.

As always, he notes, the reweighting and rescaling create a cascade of data analytic modeling and reforecasting. “While CMS maintains the mantra of continuous improvement, the shifting areas of emphasis and focus generate uncertainty, as well as re-jiggering of health plan programs that, in many cases, devolve down to the provider level,” Mowll says.

Furthermore, the plan-level adaptations, as they translate to their contracted providers, can sometimes be inconsistent from payer to payer. As a result, this can create confusion and adjustments at the provider office level, he says.

Organizations only had a short turnaround (until August 17) to validate the accuracy of measure-level data, and they can expect to receive their draft 2019 ratings in early September during the second plan preview.

Changes to the 2019 Star Ratings were first outlined in detail by CMS in the April 2 Call Letter. The agency confirmed those changes were implemented in an August 8 Part C and D User Group Call.

Here are the highlights:

New measures

  • Part C: Statin Therapy for Patients with Cardiovascular Disease (HEDIS)
  • Part D: Statin Use in Persons with Diabetes (PQA)

Measure specification changes

  • Members Choosing to Leave the Plan (Part C & D): Added an exclusion for members affected by Plan Benefit Package (PBP) service area reductions if those reductions mean there will be no PBPs left within the contract that the enrollee is eligible to enroll into.  
  • Improvement measures (Part C & D): Added Improving Bladder Control, Medication Reconciliation Post-Discharge, Getting Care Quickly, Customer Service, Care Coordination to measure calculation.
  • Adherence measures (Part D):
    • Excluded beneficiaries with ESRD for Hypertension and Diabetes Adherence measures.
    • Day of discharge counted in Proportion of Days Covered adjustment in all Adherence measures.

Deleted measure

  • Part C & D: Beneficiary Access and Performance Problems (BAPP)

Scaled Reductions for Independent Review Entity (IRE) Data Issues

  • Part C measures: (Plan Makes Timely Decisions about Appeals; Reviewing Appeals Decisions)
  • Part D measures (Appeals Auto-Forward and Appeals Upheld)

2019 Scaled Reductions

  • 2017 Timeliness Monitoring Project (TMP) data.
  • Statistical criteria to reduce a contract’s appeals measure-level Star Ratings.
  • Reductions range from 1 to 4 stars:
    • More significant IRE data quality issues garner more significant reductions.
    • Maximum reduction is 4 stars, which results in a 1-star measure rating.

2019 Socioeconomic/Disability Adjustment Categorical Adjustment Index (CAI)

The measures used to determine the 2019 CAI adjustment are:

  • Annual Flu Vaccine
  • Breast Cancer Screening
  • Diabetes Care – Blood Sugar Controlled
  • Medication Reconciliation Post-Discharge
  • Osteoporosis Management in Women who had a Fracture
  • Reducing the Risk of Falling
  • Plan All-Cause Readmissions
  • Part D Medication Adherence for Hypertension
  • MTM Program Completion Rate for CMR

Disaster policy

CMS said in its April letter it would adjust the 2019 and 2020 Star Ratings of contracts hit hard by the hurricanes and wildfires in 2018 and consider the effects of extreme and uncontrollable circumstances that occurred during the performance period.

Interested in learning more? Oftentimes, the best way to learn how other plans are adapting is to come to a live conference and hear from peers presenting their approaches and strategies. Check out our upcoming live event, The 9th Annual RISE Star Ratings Master Class, for cutting-edge strategies to boost Star scores.

If you are unable to attend a live conference, keep tuned for webinars from the RISE Association. Our calendar of webinars is regularly updated with new speakers and webinar dates.

Don’t see an event that addresses your needs? Send us a note and we will survey our faculty and speakers to see if we can accommodate your request.