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Learning from 2022 Star Ratings and planning for 2023–2024

The 2022 Star Rankings are in—and lots of well being plans must be proud of the outcomes. Amid modifications that occurred over the previous two years to regulate to the pandemic and extra modifications on the horizon, many plans improved their scores and secured excessive scores. Cotiviti’s High quality Intelligence shoppers noticed spectacular leads to the 2022 Star Rankings, many bettering their general score considerably:

  • 24 plans (39% of eligible shoppers) achieved a 5-star score (up from 8 in 2021):
    • 11 plans improved from 4.5 to five stars
    • 3 plans improved from 4 to five stars
    • 1 plan improved from 3.5 to five stars
  • 52 plans (85% of eligible shoppers) achieved a 4-star score or greater
  • 0% of eligible consumer plans achieved a decrease score than in 2021

However at the same time as we rejoice sturdy scores for 2022, well being plans ought to pay attention to how they achieved this success and regulate upcoming modifications for 2023 and 2024. Listed here are some traits and modifications that well being plans ought to pay attention to from this previous yr in addition to traits to look at for within the coming years.

Confirmed methods to jumpstart HEDIS® and Star Rankings success in 2022

2022 Star Rankings modifications because of COVID-19

To account for modifications in care introduced on by the COVID-19 pandemic, CMS carried out a number of modifications for Star Rankings 2022, together with:

  • Using “higher of” methodology: This transformation allowed plans to rely information from both the 2021 or 2022 Star Rankings, giving them the advantage of selecting a earlier yr with higher information.
  • CAHPS® member expertise: CAHPS is altering the relative weighting of affected person expertise measures. For the 2021 Star Rankings, the load modified from a 1.5x to 2x, and is ready to extend but once more within the coming yr to 4x, thus inserting extra emphasis on member expertise over outcomes.
  • Removing of 3x-weighted HOS measures: As a result of COVID-19 impacts, CMS elected to take away Bettering/Sustaining Bodily Well being and Bettering/Sustaining Psychological Well being measures from the calculation, offering a lift to most plans’ scores.

On account of these modifications, many plans achieved greater scores this yr, with extra incomes 4 stars and above.

Upcoming Star Rankings modifications for 2023/2024

The upper scores achieved on common in 2021, nonetheless, will not be replicated sooner or later. We anticipate that 2023 and 2024 will present extra correct and well timed scores for every plan for one essential motive: CMS has indicated that COVID-19 can have much less of an influence on 2023 Star Rankings because the “guardrails” that had been eliminated shall be again in place, and the “higher of” methodology is not going to be an choice. Well being plans will submit calendar yr 2021 information as common and wish to arrange for additional modifications, equivalent to:

  • CAHPS member expertise weights enhance to 4x for 2023. The give attention to member expertise has been the first concern during the last calendar yr, guaranteeing that plan members have distinctive interactions with the healthcare system, particularly within the face of challenges posed by COVID-19.
  • 3x-weighted HOS measures will stay on the show web page for the following three years and due to this fact gained’t be counted, returning to 2026 Star Rankings. The absence of those measures within the coming years will recalibrate the general contract score to lower the influence of the HOS class of measures.
  • Controlling Blood Strain (CBP) will return to the 2023 Star Rankings after methodology updates with a 1x weight. Plans will have the ability to make the most of digital outcomes for this measure for members with hypertension. This measure may even enhance to a 3x weight for the 2024 Star Rankings, growing its influence on scores.
  • 2024 Star Rankings modifications focus partially on care transitions, together with the next 1x-weighted measures:
    • Plan All-Trigger Readmissions (PCR): This measure will return to the Star Rankings program with substantive modifications for 2024.
    • Transitions of Care (TRC): This new measure assesses post-discharge factors of transition from inpatient amenities with three new indicators.
    • Observe-Up After Emergency Division Go to for Individuals with A number of Excessive-Danger Power Situations (FMC): This new measure tracks the proportion of adults with a number of high-risk situations who had a follow-up service inside seven days of their go to.

How one can discuss to management and plan forward for Star Rankings modifications

The influence of COVID-19 on 2022 Star Rankings should be understood and communicated inside well being plan management with the intention to proceed bettering high quality, value, and member expertise. Leaders should have visibility into precise plan efficiency in 2020 to know how the plan will thrive amid upcoming modifications to Star Rankings. Plans ought to use calendar yr 2020 information to tell budgeting and planning initiatives for calendar yr 2022, quite than counting on Star Ranking scores alone.

The 2022 Star Rankings noticed will increase in nationwide averages throughout many expertise measures in addition to medicine measures. The 2023 and 2024 Star Rankings modifications will extra precisely replicate CMS’s mission to enhance expertise and outcomes, particularly for these members who’re “high-touch” throughout the healthcare system. Care transitions and post-acute comply with up are paramount.

The underside line: take a second to rejoice 2022 Star Rankings successes, however hold your foot on the gasoline as we full this yr and hit the bottom operating in January.

Searching for extra info on tips on how to jumpstart your subsequent Star Ranking? Watch our webinar, Hitting the bottom operating in 2022: Getting a jumpstart on HEDIS® and Star Rankings on demand as our consultants talk about membership wants, shopper engagement, and key dates and updates within the coming years.

Watch the on-demand webinar

HEDIS® is a registered trademark of the Nationwide Committee for High quality Assurance (NCQA).

CAHPS® is a registered trademark of the Company for Healthcare Analysis and High quality (AHRQ).

 

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