The Great Stars Recession – Headwinds in the Stars Program Forecasts Decreasing Scores and Decreasing QBP Revenue 

Andrew Bell

Senior Manager

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SY2022: Unprecedented Success

SY2022 was the highest performing Star Year on record with a total of 219 contracts improving their Star Rating, while only 3 plans experienced a decrease in performance. This boom time for Star Ratings was driven primarily through relaxed rules within the Rating System due to COVID-19 impacts. These relaxed rules are due to expire for the upcoming SY2023 ratings release. This means that for the first time since SY2021, plans will utilize pure data without the assistance of relaxed rules.

Moving forward into SY2023 and SY2024, every Stars contract will be impacted by additional changes to the Stars Program. These changes, either already in effect or pending to be in effect, have the strong possibility to negatively impact contracts. These headwinds include:

  • Member Experience Weight Changes 2x - 4x (SY2023)
  • Tukey Outlier Deletion Impact (SY2024)

Below we provide critical information for Health Plans and Stars Leaders as we approach SY2023 data release.

Member Experience Weight Changes

SY2023 will see the full x4 weight impact of the Member Experience measure changes. ProspHire has spoken about this change in the past and has provided key insights into how Health Plans can deploy strong Member Engagement strategies to significantly impacts Stars.

Health Plans will need to double down on the work they’ve been doing on the CAHPS and Disenrollment measures and continue to focus efforts on ensuring a positive member experience with the Health Plan.

Tukey Outlier Deletion (SY2024 Impact)

Tukey outlier deletion is a standard statistical methodology for removing outliers with the goal of increasing the stability and predictability of the Star measure cut points and ultimately reduce Quality Bonus Payments. Measures that will see the biggest impacts are those with cut points most separated or wide. It is also estimated that by 2030, Quality Bonus Payments will be reduced by nearly $4 billion dollars.

This change will have a dramatic impact on measure performance at both the lower range and upper range of the current cutoff thresholds. According to preliminary analysis by the Federal Register, if these proposed changes would have been implemented for the 2018 Star Ratings, 16 percent of Health Plans would have decreased by half a star.

To provide deeper analysis, our analytics partner, Hyperlift, applied the Tukey methodology to SY2021 data (non-COVID impacted data) to examine the impact it would have had across the health plan landscape. For this article, they used the average SY2021 scores for each measure and showed what the impact would have been. You can see, in this graphic below, that the average plan would have had the Star ratings changed on eight measures (all but one of those changes resulted in Star rating drop), which would have resulted in losing a total of 15 basis points.

Stars Program Recession Chart

At ProspHire, we continue to partner with Health Plans to offer insights, analysis and execution strategies to improve Star ratings. Do you need support to protect against the impending Star Rating decline? Contact us for a free Tukey Impact Analysis specific to your contract.