New CMS Star Ratings were released on October 6 and offered a few surprises. 2023 saw a return to more normal evaluations overall and a return to earth for MA-PD plans. This was notable following the record-high ratings of 2022 when most plans took advantage of being able to choose the better of their measure levels and aggregate performance from 2019 and 2020.
Average ratings in 2022 were 4.37, while for 2023, average ratings were 4.15. Additionally, 51% of plans that will be offered in 2023 earned 4 Stars or higher for their 2023 overall rating, compared to 68% of plans in 2022 earning 4 Stars or higher.
Here are four trends you need to know about this year’s CMS Star Ratings (and what you can do about them):
1. Cancer Screenings Continued To Decline
During the height of the COVID-19 pandemic, Medicare members following shelter-in-place orders sparked a decline in breast cancer and colorectal cancer screenings that has slowed but not yet rebounded.
An analysis of CMS’ 2023 Medicare Advantage and Part D Star Ratings Fact Sheet shows that the national average measure score for breast cancer screening was down 0.74 compared to 2022 and down 4.3 compared to 2021. An increase in at-home stool testing appears to have offset some of the decline in colorectal cancer screening, but this measure also saw a 0.54 decline from 2021 and a 1.9 decline compared to 2020.
What To Do
Due to the suspension of data reporting during the COVID-19 pandemic, an increased weight on CAHPS, and the security of performing well historically in cancer screening HEDIS measures, many plans took these measures for granted. Studies show that breast cancer is the most costly cancer to treat, followed by colorectal cancer, which indicates that plans can’t afford to take their eye off the ball where cancer screenings are concerned.
One way plans can refocus on preventive screenings is by utilizing Annual Wellness Visits (AWVs). AWVs provide early detection of chronic disease and the opportunity to discuss advanced care planning, including breast cancer or colorectal screenings. With roughly 70% of Medicare members and 81% of Medicaid members completing an AWV before completing any other high-value activity, AWVs are an untapped resource that can positively impact overall quality scores, risk adjustment, and member satisfaction for plans.
2. CAHPS Scores Are Down Across The Board
Even with plans’ heightened emphasis on the CAHPS survey, members’ experience with their health plans continues to slide. For example, all six measures in Domain 3 showed an average decline during the last CAHPS survey that ran from March through June 2022:
|Getting Needed Care|
|Getting Appointments and Care Quickly|
|Rating of Health Care Quality|
|Rating of Health Plan|
Meaningful drops in Getting Needed Care and Getting Appointments and Care Quickly speak volumes about the struggles plans have had maintaining strong provider networks in an environment where practitioners are in short supply.
What To Do
Member engagement and member satisfaction are year-round endeavors. Surveying members to uncover areas of dissatisfaction (and addressing them quickly) is key to improving members’ impressions of your health plan. Even in the absence of an off-cycle survey response, being attentive to members who are most likely to be dissatisfied can ensure you identify irritations before they manifest as poor CAHPS survey scores.
Members who call your call center, who are new to your plan, and who have experienced (or will experience) a change in their benefits are your most likely candidates for dissatisfaction. Therefore, outreach to new members and those who have had changes in their plans is critical to addressing issues before they balloon out of control.
3. Voluntary Member Churn Reached A New High
An oft-overlooked Star Rating measure, Members Choosing to Leave the Plan, can be a bellwether for your plan’s overall health. In 2023 ratings, average voluntary member attrition increased to 17.15%, an increase of almost 2.5 points compared to 2022. These are members choosing to disenroll from their MA plans and, likely, enroll with another.
In Medicare Advantage, it typically takes a payer four years to recoup their acquisition costs and for a member to become profitable. A 2019 report by the Kaiser Family Foundation found that the gross margin for Medicare Advantage plans was $1,608 per covered person. If an average MA plan with 50,000 lives sees 8,500 (17.15%) of their members voluntarily quitting the plan each year, that’s a gross margin loss of more than $13.6M that needs to be made up through member acquisition.
What To Do
Member satisfaction and member retention go hand in hand. While all plans see some voluntary attrition each year, the most successful often perform significantly better on Members Choosing to Leave the Plan than the market average. In addition, member engagement and education—ensuring members are educated about, utilizing, and even rewarded for taking advantage of their benefits—can break the cycle of member attrition.
4. Contracts’ Overall Star Ratings Fell Significantly
After reaching record highs in 2022 (as a result of the methodology used to calculate Star Ratings during the Public Health Emergency), ratings not only fell back in 2023, they fell back dramatically.
Although the numbers of 4- and 5-Star contracts fell across the board year over year, the number of plans achieving 4.0, 4.5, or 5.0 Stars remains substantially higher than 2021 levels. For example, in 2022, 73% of contracts achieved a Star Rating of 4.0 or better, but in 2023 only 51% did so.
In 2022, nearly 90% of Medicare Advantage beneficiaries were enrolled in an MA contract rated at 4.0 Stars or higher. These latest ratings adjust that figure to 72%. Simply put, almost half of all Medicare Advantage contracts did not achieve at least a 4.0-Star Rating, and those contracts compete for only about 28% of all Medicare Advantage members.
What To Do
Improvement in CMS Star Ratings isn’t about any one thing. Quality relies on the orchestration of a host of factors. Taking a member-centric approach is key to closing gaps in care, ensuring member satisfaction, addressing social needs screening and interventions (SNS-E), improving medication adherence, and driving the completion of health risk assessments.