The Centers for Medicare & Medicaid Services (CMS) recently announced it will require carriers that offer health plans on the federal and state health insurance exchanges to display star ratings beginning with the 2020 open enrollment period. The move is leading the industry into an exciting and long-awaited phase of public transparency in health care financing and delivery, says Kevin Mowll, executive director of the RISE Association.

Although Medicare Advantage plans have displayed star ratings for years, this is the first time CMS has required that health plans on the exchanges display their ratings using the five-star Quality Rating System (with five stars representing the highest quality). The move will provide consumers with easy-to-understand information to compare quality, along with the price, of health plans on exchange websites, said CMS Administrator Seema Verma in the announcement.

Plans will display their overall star ratings as well as the number of stars they received in the three categories that make up the overall rating: medical care, member experience, and plan administration. Medical care is based on how well the plans’ network providers manage member health care, including providing regular screenings, vaccines, and other basic health services. Member experience is based on surveys of member satisfaction with their health care and doctors and ease of getting appointments and services. Plan administration is based on how well the plan is run, including customer service, access to needed information, and network providers ordering appropriate tests and treatment. The full list of 38 measures is available here.

CMS tested the use of star ratings on in Virginia and Wisconsin during the 2017 and 2018 open enrollment periods and last year expanded the pilot to include Michigan, Montana, and New Hampshire. Due to the success of these pilots, it will expand to all states during the 2020 open enrollment period ((Nov. 1-Dec. 15, 2019).

'A watershed moment' in health care financing and delivery

Mowll welcomed the decision to roll out the program to the health insurance exchanges, noting it was a long time coming–this fall will be the fifth year of the Affordable Care Act (ACA) marketplace operations.

“This is a watershed moment when the long-promised public transparency and accountability of the Medicare Advantage Stars program comes to life in the ACA marketplace,” he said.

The five-star model will be familiar to issuers of qualified health plans (QHPs) and will be helpful to consumers who shop for coverage in the marketplace as they will be able to reference actual performance of plans from 2018.   

“While bonus payments like those available in the Medicare Advantage program are not featured in the ACA for the marketplace, the idea is that this transparency will help drive membership choices among the shoppers, which is incentive enough for QHP issuers to pay attention,” he said. “Like the analogous Medicare Advantage Stars program, the metrics for health care quality will rest on HEDIS measures and the consumer satisfaction will arise from member surveys.”

One big customer concern among ACA plans has been the reliability of provider network descriptions used in marketing to the public, according to Mowll. With narrow networks and with provider opt-out decisions, he said it is likely this issue will color the attitudes and satisfaction levels among plan members. It’s possible that other sore points may emerge once the star results are made public.

“Since the populations enrolled in health insurance exchanges is quite different to those in Medicare Advantage plans, everyone will be watching to see the reactions of consumers,” Mowll said. “Will it drive choices between competing plans?  How will the simple transparency affect the ultimate enrollment patterns?  How will any of that impact the actions of QHP issuers in the marketplace?  We will find out very soon.”

Editor’s note: RISE will take a deep dive into how Medicare Advantage plans can improve their star ratings at the 10th annual RISE Star Ratings Master Class, Dec. 12-13, in Carlsbad, Calif. Click here to see the full agenda.