5 Things Medicare Advantage Plans Can Do to Improve Their Star Ratings

Established in 2007, the Medicare Advantage Star Ratings system was envisioned as a tool for consumers to help select a plan.¹ On a recent Managed Care Cast episode, Marge Ciancetta, the product manager of Cotiviti’s Star Intelligence solution, called Star Ratings the grading system for Medicare Advantage plans.²

Plans are graded from 1 to 5 overall and for about 40 individual measures, 1 being the worst and 5 being the best. These ratings are based on their performance across various categories, like member experience, customer service, managing chronic conditions, staying healthy, and drug safety and pricing accuracy.³

Each measure is scored against a cut point and is assigned a weight, signifying its importance.² To get an overall score, CMS aggregates the weight and stars assigned to each measure in a weighted average. This year, the average overall Star Rating for Medicare Advantage Part D plans was 4.04, with only 5.69%(n = 31) of plans receiving 5 stars.⁴

However, regulators are constantly tweaking the Star Ratings rubric due to performance history, market trends, and the industry’s overarching goals.⁵ Therefore, new measures, methodologies, and rules are continuously implemented.² Here are 5 strategies health plans can use to keep up with CMS regulators and improve their Medicare Advantage Star Ratings.

Health plans can improve their Medicare Advantage Star Ratings by using these 5 strategies. | Image Credit: Prostock-studio - stock.adobe.com

1. Improve relationships with members

To help better understand members, plans can adopt digital tools that compile various data sources, like claims, clinical, and prescription data.⁵ These platforms should include intelligent clinical workflows that update often to know when to contact members. For example, a digital tool can keep track of medication adherence and flag members at elevated risk of nonadherence, prioritizing them for outreach.

For outreach, plans should employ or partner with clinical staff trained in person-centered strategies, like motivational interviewing, to encourage open communication with patients; members are more likely to respond positively to interactions catered to their health needs.

However, plans should also understand the best way to reach people.² For example, plans may have better success reaching younger patients through the health care portal, but they may need to go directly through providers to reach older members in a long-term care facility.

2. Ensure credit for all work done

Plans should ensure that all their gap closures are documented so they get credit for them. This includes if their provider took a member's blood pressure or their pharmacist performed a medication recommendation or review with a member after leaving the hospital.

Additionally, case management notes contain a lot of available information, which plans can turn into supplemental claims for services performed.

3. Cover more measures by grouping them thematically

Since there are about 40 measures, it may be difficult for plans to address all individually. To address a larger amount of measures, plans can group them thematically based on each member's focus, taking a whole-person approach.

For patients with diabetes, for example, plans should not just help members address blood sugar control. They should also help with kidney evaluations, eye exams, and medication adherence. With this approach, plans can better understand members' whole picture and help them overcome any care obstacles.

"The diabetes measures carry a total weight of 9 and medication adherence measures also carry a total weight of 9," Ciancetta said. "If you can figure out the themes that make the most sense for your plan and put those measures together, then you can attack them as a whole."

4. Be prepared for changes

As mentioned, regulators are constantly tweaking the Star Ratings rubric, with new measures, methodologies, and rules continuously implemented.⁵ For example, CMS reduced the weight of Consumer Assessment of Healthcare Providers & Systems (CAHPS) measures for the 2026 Star Rating (measurement year 2024) from 4x to 2x; this lowers the overall weight of member experience measures from 33% to 22% of the total rating. Despite this shift, plans are still expected to improve medication adherence, provide optimized experiences, and reduce socioeconomic barriers to access.

Conversely, CMS recently introduced the Health Equity Index, which rewards plans for improving care for populations with social risk factors.² To qualify for the maximum reward, plans must have a portion of beneficiaries with social risk factors higher than the median. Although this will not go into effect until the 2027 Star Ratings, it will be based on data from 2024 and 2025. Therefore, being flexible and adjusting to these changes will help plans boost their Star Ratings.

5. Optimize your math

Ciancetta called Star Ratings a "numbers game," noting that it is okay if plans are not considered 5 stars in each area. Instead, she suggested that plans understand where the cut points will be set for each measure and what changes are coming before setting their goals.

"If you can't be at 5 stars, can you make it to the next cut point?", Ciancetta said. "Can you do something like trigger significant improvement for that measure that will help with the improvement measures? So, there's a lot of different strategies, but you have to figure out the math path that works for your plan specifically."

References

1. Sprague L. The Star Rating system and Medicare Advantage plans. NIH.gov. Published May 5, 2015. Accessed August 16, 2024. https://www.ncbi.nlm.nih.gov/books/NBK560455/#:~:text=The%20Star%20Ratings%20system%20for
2. McCormick B. Effective strategies to enhance Medicare Advantage Star Ratings. AJMC. Published August 15, 2024. Accessed August 16, 2024. https://www.ajmc.com/view/strategies-for-improving-medicare-advantage-star-ratings
3. Lam T. What are Medicare Star Ratings? HealthPartners Blog. Published March 23, 2023. Accessed August 16, 2024. https://www.healthpartners.com/blog/what-are-medicare-star-ratings/
4. 2024 Medicare Advantage and Part D Star Ratings. CMS.gov. Published October 13, 2023. Accessed August 16, 2024. https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-star-ratings
5. Wirick G. Contributor: how to become a Star Ratings “triple threat” with CAHPS, medication adherence, and an SDOH-first approach to member engagement. AJMC. Published June 11, 2024. Accessed August 16, 2024. https://www.ajmc.com/view/contributor-how-to-become-a-star-ratings-triple-threat-with-cahps-medication-adherence-and-an-sdoh-first-approach-to-member-engagement
6. Niakan K. Russo E. Robb M. What Medicare plans should know about CMS’ recent health equity-focused initiatives. www.milliman.com. Published December 8, 2023. Accessed August 16, 2024. https://www.milliman.com/en/insight/recent-health-equity-focused-initiatives-from-cms-medicare-plans