Bouncing back from the 2023 Star Ratings

With the Centers for Medicare & Medicaid Services (CMS) releasing the 2023 Star Ratings on October 6, the concerns of many Medicare Advantage (MA) plans were realized as overall ratings declined across the industry. With most of the guardrails implemented at the COVID-19 pandemic now lifted, the average Star Rating dipped from 4.37 to 4.15 when weighted by enrollment.

Among the 507 total rated MA contracts:

• 9.7% earned a higher rating
• 48.3% earned the same rating
• 42% earned a lower rating

Among Cotiviti’s clients, 67% of rated MA contracts either improved or maintained their existing rating.

Industry-wide, the following table demonstrates how the number of MA contracts earning a 4-star rating or higher dipped from 68% for the 2022 Star Ratings to just 51% for the 2023 Star Ratings.

The impacts of the 2023 ratings are already being felt, with some major payers seeing their share prices immediately decrease in reaction to the news. Lower ratings not only impact CMS quality bonuses but also hurt enrollment, the ability to market, and can even lead to termination as an MA program in the most extreme cases.

With nearly 65% of eligible Cotiviti quality clients earning a 4-star rating or higher for 2023—and 9.1% fewer contracts declining than the industry average—here are three strategies we've learned from successful clients that can help MA plans regain their footing in the next year for improved performance.

Invest in predictive analytics

While robust reporting and dashboards are vital for tracking progress and closing gaps, MA plans need to stay one step ahead with solutions that can project not only their own future performance, but also how the entire industry is trending. This becomes increasingly important given CMS’s cut point ranges, where just one small change to a particular threshold can make or break a plan’s performance in any given measure. A recent McKinsey analysis projects that cut point changes could impact plans by $800 million in the 2024 ratings year and suggests that plans identify at-risk measures while launching targeted initiatives to address these measures.

 Integrate quality measurement and reporting systems

Between Star Ratings, HEDIS^®, and state programs such as California AMP, payers have an ever-increasing number of measure sets to track and report—and the more quality systems they have in place, the more difficult this becomes. From disparate data feeds to inconsistent reporting, the challenges of running a successful quality program only increase when new systems are added on top of old ones.

Even within the Star Ratings program, which consists of more than 40 measures across five different categories, different teams often track different measures in separate locations. By consolidating vendor solutions and tracking measures holistically, plans can not only reduce their setup, maintenance, and ongoing training costs, but deliver consistent reporting across their myriad quality programs to drive better results with greater efficiency.

Connect quality improvement with member engagement

With member experience now accounting for 57% of a plan’s overall Star Rating, MA organizations simply can’t afford to keep their quality improvement and member engagement programs in separate silos—especially with approximately 4 out of 10 MA members reporting that they have minimal interaction with their plans. One Cotiviti client, a large nonprofit payer, created a program that uses Quality Intelligence to trigger an alert when a member who has a care gap calls the member services department, enabling the agent to discuss that care gap and help take proactive steps to close it. This not only improves quality scores, but creates a positive member interaction that reflects well on CAHPS^® surveys.

Cotiviti’s own consumer engagement data shows that a multi-touch and multi-channel combination increases engagement and should be adopted across all member communication, beginning with the member’s initial impression when onboarding. In 2021, we conducted more than 26 million outreaches to over 10.2 million Medicare members in all 50 states through our Eliza member engagement solution—focusing on medication adherence and management, member satisfaction surveys, retention, and more—and were successfully able to engage them more than 65% of the time.

While the latest Star Ratings results show that many MA plans have lost ground, the overall market continues to remain fiercely competitive—and consumers are noticing. As noted by AHIP’s recent statement in response to the new ratings, “Medicare Advantage enrollees continue to have access to—and receive—high-quality, affordable care. We see the results in the continued growth of the program, numerous studies that demonstrate the high-quality care that enrollees receive, and sky-high satisfaction rates.” Plans that have fallen behind must make deliberate, specific investments to make up for this year’s challenges to catch up with the competition. By doing so, they will ultimately have more resources to member care and satisfaction, creating a positive cycle that will drive better scores and continued growth.

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).