The recently released 2023 Medicare Advantage (MA) Star Ratings are keeping lots of folks up at night. If you happen to work for a Medicare plan, you’re likely one of the many losing sleep trying to wrap your arms around what changed and how to improve now and in the future.
What we learned from the 2023 Star Ratings
Many plans across the country saw significantly decreased levels of performance. While we know that’s bad for business, the consequences are even more staggering for their members suffering from poor health outcomes. If you think it’s just smaller plans feeling the pain, think again. Even industry giants aren’t safe, with massive amounts of revenue at stake for low Star Rating performance.
The silver lining in all of this is that, with the right partner, the Star Ratings you desire are within reach.
Plans suffered in clinical pharmacy Star measures
Some of the most critical measures are the clinical pharmacy measures, with the two most well-known being medication adherence and comprehensive medication review (CMR) completion rates. For 2023, the majority of plans saw decreased performance in both.
Medication adherence is based on the simple principle that medications don’t work when they aren’t taken properly. However, it’s not that easy for health plans to ensure that their members are taking their medications as intended. In 2023, Medicare plans saw decreased performance in all three medication adherence measures. What’s the implication? Countless members across the country are suffering because their conditions aren’t properly managed by their medications.
Performance in CMR rates didn’t fare well for 2023 Star Ratings, either. Across both MAPD and PDP plans, performance trended downward. We can deduce that during the measurement period, there weren’t enough members receiving necessary CMRs. This is alarming, considering one of the criteria for a health plan member to qualify for a CMR is taking eight or more prescription medications. It’s critically important for chronically-ill members to receive a CMR to review medications, ask questions, and see health improvement.
Some health plans may have been relieved to see that the weighting for the Statin Use in Persons with Diabetes (SUPD) measure decreased from 3x to 1x for 2023. But when looking deeper, you’ll see that SUPD performance thresholds also increased in difficulty. Despite a lower weight, SUPD should not be disregarded. Statins are shown to reduce the risk of heart disease in diabetic members. A lack of focus could result in further disease state progression, leading to higher healthcare costs and poorer outcomes.
Member experience is paramount
The Consumer Assessment of Healthcare Providers and System survey, or CAHPS, is also an integral component of Star Ratings. CAHPS is intended to measure members’ experience with their health plans and the services they provide. It packs a punch, comprising 24% of the rating for 2022. While CAHPS has always been of importance, for the 2023 Star Ratings the weight increased 4x.
Health plans looking to improve member experience should look to the simple, yet impactful strategy of reducing touchpoints. By reducing the amount of outreach from the health plan, member experience is often improved. We know, easier said than done.
High performance is still possible with the right partner and the right programs
After the 2023 updates, health plans are scrambling for partners to boost performance in the measures they struggle with most. With member health and quality bonus payments on the line, the stakes are high and time is finite.
Finding a true partner is challenging. Health plans must begin by assessing the stability, reputation, and expertise of any potential partner. Are you merely looking for a service provider, or a vetted industry leader with proven performance? High-performing clinical pharmacy programs also require flexibility on your partner’s behalf. Membership populations vary widely from health plan to health plan, so programs should be customizable to your needs.
When it comes to measures like CMR completion rates and medication adherence, consider who will provide the consultations. Many vendors use pharmacy technicians or students. However, we know that clinical pharmacists are the ultimate medication experts, providing a higher level of care to members. Be sure to find a partner using only the most qualified clinical pharmacists to conduct member outreach to ensure you never forsake quality or member experience.
Speaking of, you’ll also want to consider a partner who can provide bundled outreach to reduce overall touchpoints and curb member abrasion. The perfect example of a bundled consultation? A CMR that, while a pharmacist is consulting a member for their annual medication review, ensures that the member is properly adherent to their medications. With this approach, the member’s overall health is optimized, and their experience is improved as they didn’t receive a second, separate call to address their medication adherence.
Don’t get left behind: 2023 and beyond
We’ve all learned a lot since the recent Medicare Advantage Star Ratings release. We know that Star Rating measurement criteria will likely continue to become more difficult. For those falling behind, it’s time to double down on quality and make sure you get to where you need to be. Look to partners providing innovative solutions, with a focus on pharmacist-led care, to help you deliver the best quality and experience to your members. The right partner can ensure that you achieve your goals as they relate to business health, maximum bonus payments, improved health outcomes, and a member experience you can be proud of.
With the right partner, it can even be possible to reach your performance goals for the entire year in just one quarter. If it sounds too good to be true, read our case study. Spoiler alert – it’s not.