Here Are the Biggest Upcoming Changes to Star Ratings

As anyone with health plan experience knows, being prepared for changes in how the Centers for Medicare & Medicaid Services (CMS) calculates Star Ratings is vitally important. Earlier this year, CMS released its 2023 Medicare Advantage and Part D Rate Announcement. Included in this announcement were several proposed changes to the current methodology, calculation processes, and future measures.

The nature of healthcare is ever-evolving—and so are Star Ratings. Here are the top three changes for Star Ratings that may impact you.

1. The Return of Pre-Pandemic Quality Measures

While it’s unlikely that COVID-19 will ever disappear entirely, CMS is changing how health plans are evaluated on managing it and other conditions. Previously, health plans were permitted to use carryover quality measures from 2021 and 2022. Practical? Certainly. Resulting in potentially inflated scores for some health plans in 2022? Highly likely.

Looking forward, health plans should focus on enhancing their member engagement. Things like regular health screenings, preventative care visits, and making up missed screenings can greatly improve member satisfaction scores—a huge component of a health plan’s overall success.

2. The Importance of Health Equity

CMS will likely develop a Health Equity Index in the coming years. This index will assess how plans screen for social determinants that may impact a patient’s ability to access care. This includes things like:

  • Food insecurity
  • Housing insecurity
  • Transportation challenges

Health plans can take steps now to better collect and document patient data regarding these disparities. Partnering with community outreach programs and offering enhanced incentives to boost community collaboration can make identifying and addressing gaps in healthcare access easier. Taking a “big picture” look at the overall benefits a plan can provide its patients is key to success in the wake of this change.

3. The Heavy Weight of Member Satisfaction Scores

In 2023, patient experience ratings will become quadruple weighted when calculating Star Ratings. The happier a plan’s patients are, the better ranked it will be. Plans should cultivate a personalized welcome and onboarding experience to keep patients happy. Leveraging data, technology, and multichannel communications foster an open line of communication between health plan staff members and patients. Health plans should consider the following:

  • Do patients understand their out-of-pocket costs?
  • Do patients have access to pertinent health education?
  • Are they receiving reminders for preventative services?
  • Is there an easy way for patients to interact with health plan team members?

Patients who feel seen, heard, and engaged by their health plans are far more likely to feel satisfied with their level of care.

Is Your Organization Prepared for 2023?

Every healthcare organization must adapt as the CMS’s requirements and regulations change over time. Being aware of the significant changes coming to Star Rankings before they occur can help any health plan make the necessary alterations to succeed. Whether that’s increasing its focus on health equity, steps to improve patient satisfaction, or a shift in quality measurements—or a combination of all three—these areas will be most influential on Star Ratings in the coming year.

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