Learning from 2022 Star Ratings and planning for 2023-2024

The 2022 Star Ratings are in—and many health plans should be happy with the results. Amid changes that took place over the past two years to adjust to the pandemic and additional changes on the horizon, many plans improved their scores and secured high ratings. Cotiviti’s Quality Intelligence clients saw impressive results in the 2022 Star Ratings, many improving their overall rating significantly:

• 24 plans (39% of eligible clients) achieved a 5-star rating (up from 8 in 2021):
  • 11 plans improved from 4.5 to 5 stars
  • 3 plans improved from 4 to 5 stars
  • 1 plan improved from 3.5 to 5 stars
• 52 plans (85% of eligible clients) achieved a 4-star rating or higher
• 0% of eligible client plans achieved a lower rating than in 2021

But even as we celebrate strong ratings for 2022, health plans should be aware of how they achieved this success and keep an eye on upcoming changes for 2023 and 2024. Here are some trends and changes that health plans should be aware of from this past year as well as trends to watch for in the coming years.

2022 Star Ratings changes due to COVID-19

To account for changes in care brought on by the COVID-19 pandemic, CMS implemented several changes for Star Ratings 2022, including:

• The use of “better of” methodology: This change allowed plans to count data from either the 2021 or 2022 Star Ratings, giving them the benefit of choosing a previous year with better data.
• CAHPS^® member experience: CAHPS is changing the relative weighting of patient experience measures. For the 2021 Star Ratings, the weight changed from a 1.5x to 2x, and is set to increase yet again in the coming year to 4x, thus placing more emphasis on member experience over outcomes.
• Removal of 3x-weighted HOS measures: Due to COVID-19 impacts, CMS elected to remove Improving/Maintaining Physical Health and Improving/Maintaining Mental Health measures from the calculation, providing a boost to most plans’ ratings.

As a result of these changes, many plans achieved higher ratings this year, with more earning 4 stars and above.

Upcoming Star Ratings changes for 2023/2024

The higher ratings achieved on average in 2021, however, may not be replicated in the future. We expect that 2023 and 2024 will show more accurate and timely ratings for each plan for one critical reason: CMS has indicated that COVID-19 will have less of an impact on 2023 Star Ratings as the “guardrails” that had been removed will be back in place, and the “better of” methodology will not be an option. Health plans will submit calendar year 2021 data as usual and need to prepare for further changes, such as:

• CAHPS member experience weights increase to 4x for 2023. The focus on member experience has been the primary concern over the last calendar year, ensuring that plan members have exceptional interactions with the healthcare system, especially in the face of challenges posed by COVID-19.
• 3x-weighted HOS measures will remain on the display page for the next three years and therefore won’t be counted, returning to 2026 Star Ratings. The absence of these measures in the coming years will recalibrate the overall contract rating to decrease the impact of the HOS category of measures.
• Controlling Blood Pressure (CBP) will return to the 2023 Star Ratings after methodology updates with a 1x weight. Plans will be able to utilize digital results for this measure for members with hypertension. This measure will also increase to a 3x weight for the 2024 Star Ratings, increasing its impact on scores.
• 2024 Star Ratings changes focus in part on care transitions, including the following 1x-weighted measures:
  • Plan All-Cause Readmissions (PCR): This measure will return to the Star Ratings program with substantive changes for 2024.
  • Transitions of Care (TRC): This new measure assesses post-discharge points of transition from inpatient facilities with three new indicators.
  • Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC): This new measure tracks the percentage of adults with multiple high-risk conditions who had a follow-up service within seven days of their visit.

How to talk to leadership and plan ahead for Star Ratings changes

The impact of COVID-19 on 2022 Star Ratings must be understood and communicated within health plan leadership in order to continue improving quality, cost, and member experience. Leaders must have visibility into actual plan performance in 2020 to understand how the plan will thrive amid upcoming changes to Star Ratings. Plans should use calendar year 2020 data to inform budgeting and planning initiatives for calendar year 2022, rather than relying on Star Rating scores alone.

The 2022 Star Ratings saw increases in national averages across many experience measures as well as medication measures. The 2023 and 2024 Star Ratings changes will more accurately reflect CMS’s mission to improve experience and outcomes, especially for those members who are “high-touch” within the healthcare system. Care transitions and post-acute follow up are paramount.

The bottom line: take a moment to celebrate 2022 Star Ratings successes, but keep your foot on the gas as we complete this year and hit the ground running in January.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

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