In this bonus episode, we welcome Stars expert, Megan Piotrowski, for an in-depth review of the recent Star Ratings release. On October 13, 2023, the 2024 Medicare Advantage and Part D Star Ratings were published on Medicare Plan Finder, largely representing Measurement Year 2022 data submitted to CMS.

We discuss the variables that influenced performance and why it's the second year in a row, the average Star Ratings have declined and some plans might be seeing less than ideal performance. More than a third of plans saw a Star Ratings decline this cycle.

Tune in to learn about the changes that will impact 2024 performance including the Tukey Outlier Deletion Method, the transition of several HEDIS measures to Electronic Clinical Data Systems (ECDS),  measure weight changes, and more.

Host: Today, we’re talking with Megan Piotrowski for a bonus episode inspired by the recent release of the 2023 Star Ratings.  

Megan Piotrowski is a Star Ratings and quality strategy manager evaluating market trends and the competitive landscape to develop initiative offerings and long-term strategies for the continued maintenance of 4-Star Ratings. Megan has held a variety of regulatory, quality leadership, and consultant roles across the continuum of healthcare. She’s led the quality improvement initiatives on behalf of health plans across all lines of business, as well as for health systems, providers, and community and government-based organizations. She holds a Master of Science in Health Informatics from Northwestern University. Welcome Megan.  

Megan: Hi, it’s great to be here.  

Host: Megan, as you know, on October 13, 2023, the 2024 Medicare Advantage and Part D Star Ratings were published on Medicare Plan Finder, largely representing Measurement Year 2022 data submitted to CMS. CMS publishes Medicare Part C and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by members enrolled in MA and PDP or Part D plans. This system is intended to provide consumers the opportunity to compare the quality of the Medicare plans available to them prior to their enrollment or re-enrollment.

Megan, Can you provide some high-level insights on how the industry performed after this release?  

Megan: Approximately 42% of MAPD plans, about 229 contracts, received 4 Stars or higher for their overall ratings, down from 51% last year. This means 74% of MAPD members are currently enrolled in contracts that will have 4+ Stars in 2024. A total of 31 MAPD contracts earned 5 Stars, down from 57 for the 2023 Stars, while there are 6 total contracts with 2 Stars or below – last year, there was only 1.

The average MAPD 2024 Star Rating is 4.04, down from 4.14 in 2023. This is the lowest the average has been since 2017.

For the second year in a row, the average Star Ratings have declined, so some plans might be seeing less-than-ideal performance. More than a third of plans saw a Star Ratings decline this cycle.

Some plan details do generally influence Star Ratings: Organizations that are non-profit frequently earn higher ratings; Established plans (those with 10+ years in the program) are more likely to earn 4 Stars or above. There are some specific attributes about this program year that could also explain plans’ 2024 Star performance.

Host: Let’s talk about changes to Star Ratings that will impact 2024 performance. You know, what are some details on this program year that may shed light on additional reasons why plans may be seeing changes in performance?  

Megan: The updated Plan All-Cause Readmissions (Part C) measure 1 was re-specified and transitioned off the display page into the 2024 Star Ratings as a new measure with a weight of 1 for the first year.  

The Diabetes Care – Kidney Disease Monitoring measure was retired.  

Both the Transitions of Care (Part C) and Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (Part C) measures were added, each with a weight of 1.  

The weight for the Part C Controlling Blood Pressure measure was increased from 1 to 3.

Industry Buzz: Introduced Tukey outlier deletion methodology when calculating cut points for all non-CAHPS measures. This statistical method involves removing outlier contract scores prior to applying mean resampling, a process used to remove extreme outliers from measure scores prior to defining the measure-level cut points. While this was intended to improve the predictability and stability of the overall Star Ratings, CMS has acknowledged that they fully expect this method will make it harder for plans to earn and/or keep their high Star ratings, as it’s likely extreme outliers are more common on the lower end of the score distribution. It appears perhaps that high-performing plans – those 4 and 3.5 performers – were hit hardest by the Tukey outlier deletion method.

There is some industry drama surrounding this introduction of the Tukey method due to some final regulatory text codification errors.

Member satisfaction scores were rated higher than ever before, measures such as perceived accessibility and quality of care. Plans decrease performance is likely at least partially influenced by this major calculation change.  

Host: Based on what you’re seeing, where do you see the industry headed? What do you anticipate in the years to come?  

Megan: Looking ahead, it’s pivotal to remain nimble, as there are continuing changes to the Star Ratings.

In this current Measurement Year, the beginnings of transitioning several HEDIS measures to Electronic Clinical Data Systems (ECDS) non-hybrid reporting Include weight changes such as increasing the Plan All-Cause Readmissions to triple-weighted.

Starting just ahead in Measurement Year 2024, we know the CAHPS and Administrative Patient Experience weights will move back down from 4 to 2, re-focusing the overall Star Ratings back onto HEDIS; the return of several revamped measures such as Kidney Health for Patients with Diabetes; the addition of web-based CAHPS surveying models; the potential removal of those cutpoint guardrails and removal of those Hold Harmless provisions that a lot of us rely upon; and the highly-anticipated replacement of the current Reward Factor with the Health Equity Index.

We’ve got a lot to do yet in the 4th quarter to influence the 2025 Star Ratings, and there is plenty more excitement and changes ahead for those of us in this space. Never a dull day for those of us in Stars world, and just really highlights the importance of an organization’s overall Stars strategy, the ability to accurately project performance, and the tenacity to achieve both stability and continuous improvement in the quality performance journey

Host: Megan, thank you for joining today and providing insights on what’s happened and what needs to be done for continued progress in Stars performance. To all our listeners, if you liked this episode, share it on LinkedIn with your colleagues, follow and leave a review on Apple Podcast or Spotify.