Star Ratings Impact: 2023 Medicare Advantage and Part D Rate Announcement

Andrew Bell

Senior Manager

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CMS Advanced Notice Summary:

On April 4th, 2022, CMS released their 2023 Medicare Advantage and Part D Rate Announcement. This notice contained several proposed changes to both methodology, calculation and future measures. However, the short-term impact overall is minimal in 2022 and 2023. Proposed changes could potentially have to go through the rule making process and work take additional time. With each new notice from CMS, plans should always be forward-thinking.

Below, we highlight two critical considerations for Health Plans to be successful in Stars. These take into account future changes to the program and will position your plan to be successful both now and into the future.

HEDIS Impacts – Data Transformation:

CMS has announced that they are removing the hybrid reporting method for Colorectal Cancer Screening in MY2024 and transitioning the measure to electronic clinical data systems (ECDS) reporting only beginning in MY2024. For the Breast Cancer Screening measure, CMS will move the measure away from administrative collection and to ECDS collection beginning in MY2023.

What is the difference between traditional HEDIS reporting and ECDS? The ECDS method has specific guidelines for reporting data to NCQA using four data source categories: EHR, health information exchanges/clinical registries, case management system and administrative claims/enrollment. Contracts will no longer be able to assess performance based on a sample of members when the hybrid method is removed, but they can continue to use data from chart reviews if it is standardized upon abstraction and included in an electronic database. They can perform year-round chart review and have it audited as non-standard supplemental data and use it to report the measure.

Plans need to consider data transformation efforts to shore up their ECDS capabilities if, in fact, CMS decides to migrate all eligible HEDIS measures toward ECDS reporting.

Future Changes to Star Ratings – A Focus on Health Equity

CMS, in its latest ruling, hinted at several potential changes to the Star Rating program, several of which had a focus on Health Equity. These changes would come across as net new measures and calculation/methodology changes.

The biggest takeaway for health plans is not to focus in any one specific new potential measure, but to consider health equity broadly when devising Stars strategies. Forward thinking plans would be wise to consider the following:

Intelligent Data Collection

  • Plans need to rethink how they collect and document data from members (i.e., on housing security, food security, etc.). Creative plans are thinking about enhancements to Health Risk Assessments, Application Data and other data collection opportunities along the continuum of a member’s journey with the plan.

Community Collaboration

  • Health plans should consider enhanced public/private partnerships within the communities they serve. This includes improved programs and/or incentives with focuses on social risk factors and assisting members to obtain community resources available to them.

Reminders for Star Rating Measures in 2023 and Future Years:

MeasureImpact YearDescription
Care of Older Adults Functional StatusMY2021/SY2023CMS removed this measure. 
CDC- Kidney Disease MonitoringMY2021/SY2023NCQA announced the retirement of this measure after MY2021/SY2023. CMS will consider Kidney Health Evaluation for Patients with Diabetes (Display Page) as new measure with future rule making.
Patient Experience/Complaints & Access Measures (including CAHPS)MY2021/SY2023CMS increases the weight of patient experience/complaints and access measures from 2 to 4 for MY2021/SY2023.
Rheumatoid Arthritis ManagementMY2021/SY2023CMS removed this measure.
Statin Use in Persons with Diabetes (Part D)MY2021/SY2023Measure weighting changed to a 1x measure weight.
Controlling Blood Pressure (Part C)MY2021/SY2023Measure was re-specified and will be transitioned off the display page and into the SY2023 ratings.

Reminders for Star Rating Measures in 2024 and Future Years:

MeasureImpact YearDescription
Controlling Blood Pressure (CBP)MY2022/SY2024Measure will increase to a 3x measure weight.
Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC)MY2022/SY2024Measure will track the percentage of adults with multiple high-risk conditions who had a follow-up service within seven days of their visit.
Plan All-Cause Readmissions (PCR)MY2022/SY2024Measure will return to the Stars Ratings program with substantive changes.
Transitions of Care (TRC) MY2022/SY2024Measure will assess post-discharge points of transition from impatient facilities with three new indicators.