Quality Ratings

J.D. Power Survey Shows Even Best Health Plans Have Digital Dilemma

Although overall customer satisfaction rankings improved year over year in the J.D. Power 2024 U.S. Commercial Member Health Plan Study, nearly all evaluated health plans struggled to provide a high-quality digital customer experience. Indeed, one perennially high-performing plan admits that it, too, has been striving to solve the digital-experience puzzle — but it hopes that a new affiliation agreement will help by adding much-needed scale and access to capital.

This year’s J.D. Power survey measured satisfaction among 29,188 members of 147 group and individual health plans in 22 regions throughout the U.S. from January to April 2024. Plans are scored based on performance in eight core dimensions: “able to get health services how/when I want,” “digital channels,” “ease of doing business," “helps save time and money,” “people,” “product/coverage offerings,” “resolving problems or complaints” and “trust.”

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Contract Terminations Signal Tougher CMS Enforcement Amid Stars Upheaval

As changes such as the application of the Tukey outlier deletion methodology and the introduction of the Health Equity Index stand to make the Medicare Advantage landscape more competitive, CMS in recent weeks issued three contract terminations based on poor performance over a three-year period. While the COVID-19 public health emergency afforded MA and Part D insurers certain flexibilities, experts say the recent enforcement actions signal a tougher CMS coming out of the PHE.

Modern Healthcare on Jan. 8 broke the news that consistently poor Star Ratings for Centene Corp.’s WellCare Health Insurance of Arizona and WellCare Health Insurance of North Carolina would force the exits of two Medicare Advantage Prescription Drug (MA-PD) contracts from the MA market. According to separate letters to the subsidiaries dated Dec. 27, CMS decided to impose intermediate sanctions after WellCare failed to achieve a Part C summary Star Rating of at least 3 Stars in three consecutive rating periods for the specific contracts. That means the contracts had to stop enrolling new Medicare beneficiaries and cease all marketing activities, effective Jan. 12.

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Star Ratings Plummet in 2024 for Stand-Alone Medicare Prescription Drug Plans

Only 2% of Medicare beneficiaries who enrolled in a stand-alone Prescription Drug Plan (PDP) in 2024 will be in contracts with 4 or more stars, compared to 42% in the 2022 plan year and 9% in 2023, according to CMS’s recently released estimates. The average Star Rating for PDPs dropped to 3.11 in 2024 from 3.70 in 2022, with two contracts receiving 1.5 stars.

The distribution change is largely fueled by methodology changes in how many of the Star Ratings are calculated. Known as Tukey outlier deletion, the changes center on removing outlier contract scores when determining the cut points for all non-Consumer Assessment of Healthcare Providers and Systems measures.

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Provider-Sponsored Plans Cite Localized, Comprehensive Approaches to Achieving 5 Stars

Despite declines in the average overall Star Rating for Medicare Advantage Prescription Drug plans and the number of MA-PD contracts earning 4 stars or higher, the 2024 Star Ratings data released by CMS last month indicates that about two-thirds of performers held onto their 5-star rating from the previous year. For our annual series on the success stories of highly rated MA plans, leadership at several repeat 5-star performers touted comprehensive, integrated and localized approaches to continually delivering quality care.

For Quartz Health Plan, simplifying the member journey and working closely with its provider owners have been two areas of focus, according to Christina Ott, chief growth officer. Formed by the 2017 combination of Gundersen Health Plan, UnityPoint Health and Physicians Plus Insurance Corp., and then rebranded as Quartz, the insurer’s MA-PD contract serving enrollees in select counties of Minnesota has earned 5 stars for the 16th time, according to Ott. Quartz also has MA membership in Illinois, Iowa and Wisconsin; Advocate Aurora Health joined as a minority owner in 2021. While Quartz is focused on selling its products where its provider owners can best serve seniors and “has a narrower network than most,” it does have other providers in the network and it “aligns with providers in ways that work for the individual,” she tells AIS Health, a division of MMIT.

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© 2024 MMIT

5-Star Plans Focus on Data Transparency, Digital Adoption, Operations Training, Says AArete

The latest Medicare Part C and Part D Star Ratings data show that it’s getting harder for payers to achieve the bonus payment level of 4 stars or higher, in part due to cut point changes driven by the new Turkey outlier deletion methodology. As CMS continues to alter the way it calculates the Star Ratings, including lowering the weight of Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures for 2026, plans should deploy a top-down, cross-departmental government structure to incentivize quality performance across all functions, according to global management and technology consulting firm AArete.

To learn more about this and other characteristics of a 5-star MA plan, AIS Health, a division of MMIT, spoke with Darren Ghanayem, managing director with the health care payer group at AArete. The firm works with payers across the MA, Medicaid and commercial markets, advising them on everything from systems migrations and provider network strategy to maximizing revenue and optimizing administrative costs. Ghanayem previously served as chief information officer with WellCare Health Plans, prior to its acquisition by Centene Corp., and at Anthem, Inc. (now Elevance Health, Inc.).

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© 2024 MMIT

Star Ratings Plummet in 2024 for Stand-Alone Medicare Prescription Drug Plans

Only 2% of Medicare beneficiaries who enrolled in a stand-alone Prescription Drug Plan (PDP) in 2024 will be in contracts with 4 or more stars, compared to 42% in the 2022 plan year and 9% in 2023, according to CMS’s recently released estimates. The average Star Rating for PDPs dropped to 3.11 in 2024 from 3.70 in 2022, with two contracts receiving 1.5 stars.

The distribution change is largely fueled by methodology changes in how many of the Star Ratings are calculated. Known as Tukey outlier deletion, the changes center on removing outlier contract scores when determining the cut points for all non-Consumer Assessment of Healthcare Providers and Systems measures.

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Despite Top-Level Decline, Star Ratings Suggest Mostly Stable Plan Performance

Only 42% of Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered in 2024 achieved an overall rating of 4 stars or higher, compared with approximately 51% of contracts in 2023, according to the latest Medicare Part C and Part D Star Ratings data. Weighted by enrollment, the average MA-PD Star Rating fell from 4.14 for 2023 to 4.04, with approximately 74% of MA-PD enrollees estimated to be enrolled in contracts that achieved 4 or more stars for 2024, compared with 72% for 2023, CMS reported on Oct. 13.

Those changes were largely expected due to the application of the new Tukey outlier deletion methodology, which was used in determining the cut points for measures not directly related to member experience and largely achieved CMS’s stated goal of infusing more “predictability and stability” into the Star Ratings.

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© 2024 MMIT

MA-PD Star Ratings Fall for the Second Consecutive Year

Payer anxieties about lower Star Ratings for the 2024 plan year came to fruition last week with CMS’s release of the annual Part C and Part D quality measurements. The average Medicare Advantage Prescription Drug (MA-PD) contract scored a 4.04, down from 4.14 last year and the lowest average rating since 2017. Just 31 contracts received 5 stars, representing 6.8% of current MA-PD enrollment, vs. 57 contracts serving 21.5% of enrollees last year.

Several methodology changes fueled the ratings decline, which Stars experts have dubbed "TukeyGate," referring to CMS efforts to remove outliers from calculating the cut points for non-Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. The agency also added two new Part C measures, one for care transitions and another for follow-ups after emergency visits for people with high-risk chronic conditions. A Part C measure on kidney disease monitoring for diabetes patients was removed.

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© 2024 MMIT

Despite Top-Level Decline, Tukey-Impacted Star Ratings Suggest Mostly Stable Performance

Only 42% of Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered in 2024 achieved an overall rating of 4 stars or higher, compared with approximately 51% of contracts in 2023, according to the latest Medicare Part C and Part D Star Ratings data. Weighted by enrollment, the average MA-PD Star Rating fell from 4.14 for 2023 to 4.04, with approximately 74% of MA-PD enrollees estimated to be enrolled in contracts that achieved 4 or more stars for 2024, compared with 72% for 2023, CMS reported on Oct. 13.

Those changes were largely expected due to the application of the new Tukey outlier deletion methodology, which was used in determining the cut points for measures not directly related to member experience and largely achieved CMS’s stated goal of infusing more “predictability and stability” into the Star Ratings.

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© 2024 MMIT

Q&A: How UnitedHealth Got Top Scores in Telehealth Satisfaction

J.D. Power & Co., in the latest edition of its annual survey of consumer satisfaction with telehealth brands, gave UnitedHealthcare, the managed care arm of UnitedHealth Group, the highest marks of any insurer. The company beat out second place Kaiser Permanente and third place Humana Inc. for the top spot.

Insurers have invested heavily in telehealth since the beginning of the COVID-19 pandemic. Starting in 2020, due to pandemic lockdown orders, telehealth became a key care modality in a way that it never had been before. UnitedHealthcare, according to a press release touting the J.D. Power results, offers telehealth products such as 24-hour virtual urgent care without cost sharing and virtual primary care. The health care giant in June made 24-hour virtual care available to 5 million of its fully insured members without cost sharing.

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© 2024 MMIT