Every year, the Centers of Medicare & Medicaid Services (CMS) releases Star Ratings to determine how well Medicare plans perform. These ratings have big implications for plans including how members enroll. The system supports CMS’s efforts to empower people to make healthcare decisions that are best for them.
As for providers and plans, the factors that influence Star Ratings, and how heavily they influence them, change annually. Just when you have it figured out, they change again. This blog post explains the 2022 changes for Star Ratings, how these changes affect your telehealth strategy, and how to move forward into 2023 and 2024.
What are Star Ratings?
Plans are rated on a 1-to-5 scale, with one star representing poor performance and five stars representing excellent performance. When a plan is rated higher, more people enroll in it for a variety of reasons.
Star Ratings are based on:
- Staying healthy: How well does the plan keep members healthy through checkup reminders and communication?
- Managing chronic conditions: How well does the plan help members get recommended tests and treatments for their condition?
- Member experience: How do members rate their experience with the plan? This includes the care they receive from doctors and getting prescription medications.
- Member complaints and performance: How often do members find problems with the plan? How has the plan’s performance improved each year?
- Customer service: Does the plan have foreign language interpreters and teletypewriter (TTY) services available? Does the plan process appeals and new enrollments in a timely manner?
These categories are the main factors determining Star Ratings. However, there are other factors determining Star Ratings that change.
Keep reading to learn how 2022 Star Ratings differed from the past, and what factors influenced these changes.
2022: A record-breaking year for Star Ratings
2022 was a record-breaking year with the highest number of 4- and 5-Star Ratings. In 2022, there were more 5-Star plans than 3-Star plans.
The first reason for the increase in Star Ratings is the “better of” methodology. This change allowed plans to report data from either the 2021 or 2022. Plans had the benefit of choosing whichever year had the better data. The “better of” methodology will no longer be allowed, which means we can expect a drop in Star Ratings in the coming years.
Plans need to prepare for the future, because the CMS Star system will correct from COVID, leading to a significant loss in 4- and 5-Star Plans. Aside from the “better of” methodology, there were several other changes to 2022 Star Ratings.
Most influential change to Star Ratings in 2022: CAPHS Weighting
In 2022, Star Ratings continue to place an emphasis on member experience by having an increased importance and weighting. Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores are shifting from two times to four times weighting.
CAPHS scores are often the lower performing category for health plans. Yet, in 2022, it becomes the highest weighted in the Star Ratings. Here is a breakdown of the CAPHS measures affecting Star Ratings:
- Getting needed care
- Getting appointments quickly
- Customer service
- Rating of healthcare quality
- Rating of health plan
- Care coordination
- Rating of drug plan
- Getting needed prescription drugs
Member experience was by far the most important change in 2022 Star Ratings, and this trend will continue in the future.
More changes to 2022 Star Ratings
In 2022, the plans that scored the highest were those that showed improvement in these measures:
- Transition of Care (TRC): This measure assesses post-discharge transition from inpatient facilities.
- Medication adherence for chronic conditions: How well did the plan help patients get medications? Did the plan include refill reminders?
- Preventive services: Did the plan have the ability to reach members digitally and in a timely manner?
- Chronic conditions: Members with chronic conditions often have compromised immune systems, making them more fearful of contracting COVID-19. Did the Plan increase the use of test kits, in-home services, and mobile unites to accommodate those with chronic conditions?
- Blood pressure: Did plans engage members with uncontrolled blood pressure?
In 2022, the Star Ratings removed the Health Outcome Survey (HOS) measures. Before, they had a 3x weighting.
The removal of the HOS measures boosted most plans’ ratings, and this change will last for at least the next 3 years.
Moving forward: Stars Ratings in 2023 and 2024
2022 Star Ratings were already solidified, meaning from now on, plans need to focus on Star Ratings for 2023 and 2024.
Here are the changes we’ll see for 2023 Star Ratings:
- CAPHS: Member experience weights increase to 4x for 2023.
- Health outcomes survey (HOS): 3x-weighted HOS measures won’t be counted for the next 3 years.
- Controlling blood pressure (CBP): CBP continues to be included in 2023 Star Ratings after methodology updates with a 1x weight.
In 2024, here are the Star Ratings changes to be aware of:
- Plan all-cause readmissions (PCR): This measure will return to the Star Ratings program with changes in 2024. PCR assesses the rate of adult acute inpatient observation stays that followed an unplanned acute readmission for any diagnosis within 30 days after discharge.
- Transitions of care (TRC): This measure assesses post-discharge transition from inpatient facilities with 3 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 7 days of their visit.
The 2023 and 2024 changes to Star Ratings reveal trends to keep an eye on for the upcoming years. Now that you understand 2022, 2023, and 2024 changes to Star Ratings, we’re going to unpack how these changes impact your telehealth strategy.
How these changes impact your telehealth strategy?
By far the most important factor are CAPHS member experience measurements. How does telehealth impact member experience? Virtual visits have a higher patient satisfaction rate of 97%. In contrast, in-person visits have a 84% satisfaction rate. Just by offering telehealth services, a plan may be able to improve its Star Ratings.
When offering virtual visits, here’s how to improve patient satisfaction rates:
- Move as many experiences to virtual as possible, including prescription refills, ordering future screenings, assessments, medical recommendations, pain screenings, and depression screenings.
- Offer a Digital Mock-CAPHS Survey to better understand and improve member experience.
- Focus on how to use telehealth to improve other Stars measurements. For example, offer telehealth monitoring of blood pressure to monitor patients.
One key to improving member experience and providing higher touch care to more patients is to digitize medical services, when appropriate.
Need help providing telehealth?
With Star Rating improvements relying so heavily on telehealth, plans need to make sure their digital strategy is in great shape. Just like any other tool, there are great telehealth tools, and there are some that will just further frustrate members.
To help improve your telehealth services, rely on our Ōmcare Home Health Hub®. It ensures patients can get their medicine and speak with their providers, pharmacist, or caregivers in real-time. Reach out to Ōmcare to learn more!