Cotiviti clients outperform the field in 2021 Star Ratings

With Medicare open enrollment set to begin this week, the Centers for Medicare & Medicaid Services (CMS) has released the 2021 Star Ratings for Medicare Advantage plans with prescription drug coverage (MA-PD) as well as standalone MA and PD plans, based on data from calendar year 2019. Among Cotiviti’s clients that were eligible to receive a 2021 rating, more than 75 percent earned four stars or above at the plan level compared to 60.2 percent of all eligible MA-PD plans. Here are our takeaways from the latest data and measure changes.

Table 1. 2020–2021 overall Star Ratings distribution for MA-PD contracts (Source: CMS).

Competition among MA plans continues to accelerate

The total number of contracts, including those ineligible for a rating, went up from 743 last year to 816 this year, an increase of nearly 10 percent. Most of this increase was driven by large national payers expanding into new markets, often through acquisition of smaller plans.

As more payers continue to enter or expand their presence in the MA space and overall premiums continue to drop, the importance of performing well in the Star Ratings program will intensify as members seek the highest value for their premiums. Plans that than don’t earn four stars or above will likely find it increasingly difficult to grow their membership and recognize additional revenue gains.

More plans earn highest rating, but fewer earn four stars or above overall

Including MA-PD plans and other plan types, 28 total contracts received a coveted five-star rating, up from 23 contracts for the 2020 Star Ratings.

However, the total number of plans earning four stars or above overall went down. As shown in Table 1, nearly 77 percent of current MA-PD enrollees belong to a plan that earned four stars or above. This figure represents a year-over-year decrease from the ratings released for 2020, when more than 81 percent of enrollees belonged to such a plan.

Experience often leads to higher ratings

As noted by CMS, MA-PD plans that have been in the program for 10+ years are more likely to receive four stars or more compared to those with less experience. Indeed, 152 plans with 10+ years’ experience received such a rating compared to only 42 plans with nine years or fewer. More experienced plans are more likely to have seamless and integrated processes in place to handle the numerous annual changes to the program, especially in the administrative and member satisfaction measures, whose weight increased from 1.5 to 2 for the 2021 ratings.

Cotiviti’s takeaways for better performance in 2022

Here are three recommendations from Cotiviti based on tactics used by our high-performing MA clients.

1. Create a strong interdepartmental team comprising quality experts, member relations, provider relations, and pharmacists who meet regularly—and most importantly, track measures in one place. You can’t see the full picture and achieve an accurate prediction of your score if each team tracks performance differently and are separated by silos. One team alone can’t achieve four-star results or better.
2. Focus on the top-weighted measures first. Have the team evaluate where the low-hanging fruit lies and create a subcommittee to work measure improvement. Remember that CAHPS^® and member experience measures increase to a weight of four next year.
3. Use predictive models to inform which members you reach out to, how you should communicate with them, and when is the best time. Use a member-centric approach to enhance their experience.

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CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).