Stars 2018: Work Smarter and Not Harder

Posted October 5, 2017 by Amy Salls

The Centers for Medicare & Medicaid Services’ (CMS) dramatic changes to the 2018 Star Rating cut points have proven that taking a "cruise control" approach to quality performance will no longer ensure you remain a 4 or 5 Star plan. Achieving and maintaining high marks is a moving target and to be successful, you should find ways to work smarter, not harder, to impact quality scores.

Did your plan unexpectedly miss the 4 Star thresholds causing you to lose your Quality Bonus Payment incentive? Perhaps you just narrowly made the cut but the margin was too close for comfort?

Here are five points to consider as you continue to review your 2018 scores and work to adjust your plans and strategies for future Star Ratings success.

  1. The CMS Star cut point strategy is based on all Medicare Advantage plans performance. The highest performing plans set the pace. If you scaled back on quality performance efforts (resources, budgets, outreach, etc.) last year based on previous 4 or 5 Star success, you were likely left with flat or decreased measure performance. When CMS increased the cut points for several key measures in 2018, you might have seen a decrease in your scoring that was not anticipated. Continuous monitoring and a focus on improved member health outcomes should always be a major part of your success strategy.
  2. You are competing against yourself when it comes to individual clinical measure performance. As part of your Part C and D Quality Improvement score, these two measures are weighted 5x more when used to calculate your overall rating. Your goal should be to show continuous, year over year improvement. If you improve greatly from the previous year then this is great news, but if your individual measure performance drops significantly, the high variance in performance and the contributing weight could result in a sharp decline in your Star rating.
  3. Small emerging plans should pay particular attention to any prior year measure labeled as “not enough data”, “no data,” or “too small” to be rated. These measures should be monitored in the event that membership growth moves your plan into the thresholds for scoring. Note that “first time reported” measures factored into your scores can greatly impact your overall performance score positively or negatively.
  4. The Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcomes Survey (HOS), and other administrative measures collectively carry significant weight for Part C, Part D and overall performance scores, therefore they should not be ignored. All touch points with your members should be surveyed and monitored regularly within allowable audit guidelines to keep a pulse on access to care, provider, plan and pharmacy satisfaction, appeals, and call center contact.
  5. Relying on individual measure scores to be rounded up to achieve cut point thresholds is a risky strategy and may have cost you in your 2018 ratings performance. CMS is proving they will be consistently refining the Star Ratings program to ensure best in class quality performance. Your Stars 2019 and 2020 work plans should drive toward performance improvement and moving your scores more towards the median to ensure your ratings are solid and do not depend on rounding to make the cut.

CMS has given us a lot to think about based on 2018 overall plan Star quality performance. Some of the changes to thresholds and scoring methodology were expected, but others took the industry, and possible your rating, by surprise. But don’t panic, there is still time to impact your 2019 performance. Use the last few months of 2017 to look at measures where you didn’t perform as well as you would have liked and put together a work plan that can help you quickly identify members who would benefit most from year end, targeted interventions. If you find that you have a gap in the people, processes, or technology needed to do so, reach out to us to find out how our quality management solutions can help.

Amy Salls headshot
Amy Salls
Director
Population Health Strategies



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