Star Ratings

PDP Star Ratings Dip Amid End of Pandemic-Era Adjustments

When it comes to Star Ratings for Medicare plans, 2023 represented a return to the status quo after CMS stopped making adjustments related to the COVID-19 public health emergency that had largely inflated plans’ performance. Stand-alone Prescription Drug Plans (PDPs) were no exception to that trend, but they also continued a phenomenon seen in prior years where their overall scores trailed that of the more comprehensive Medicare Advantage-Prescription Drug (MA-PD) plans.

“In general, the PDP Star Ratings are somewhat lower than the average rating for MA contracts,” observes Shelly Brandel, a principal and consulting actuary at Milliman. That tends to happen every year, she adds, “so I think directionally the PDP Star Ratings have moved pretty similarly to MA Star Ratings [for 2023], but at a lower level.”

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Number of Highly Rated PDP Contracts Shrinks in 2023

Only 9% of Medicare beneficiaries who sign up for a stand-alone Prescription Drug Plan (PDP) in 2023 will be in contracts rated 4 stars or higher, compared to 42% in the 2022 plan year, CMS recently estimated based on current enrollment figures. The average star rating for stand-alone PDP plans declined to 3.25 in 2023 from 3.70 in 2022, with only two PDP contracts receiving a 5-star rating. The change in distribution is largely due to adjustments in measure scores, and “the unusual circumstance of nearly all contracts qualifying for the regulatory adjustment for extreme and uncontrollable circumstances” driven by the pandemic, which led to higher than normal 2022 Star Ratings distributions, CMS explained in a fact sheet accompanying the release of the 2023 Star Ratings.

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News Briefs: Reporting 3Q Earnings, UnitedHealth Group Saw Revenues Climb 12% From a Year Ago

As the Medicare Annual Election Period gets underway, CMS is warning Medicare Advantage organizations and Prescription Drug Plan sponsors that it will be closely monitoring marketing activities during and beyond the AEP, including through “secret shopping” activities. Given increasing concerns about the marketing practices of all entities, including third-party marketing organizations, CMS has engaged in secret shopping by calling numbers associated with television advertisements, mailings, newspaper ads and internet searches and discovered that some agents are not complying with current rules and are “unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision,” according to an Oct. 19 memo. However, starting Jan. 1, 2023, television advertisements will no longer qualify for CMS’s “File and Use” framework that allows materials submitted to be distributed five days after submission. Moreover, the agency will review all previously submitted television ads to confirm that materials meet CMS requirements and may take compliance action against plans that use “CMS-disapproved advertisements.” In addition, the agency during the AEP and into the new plan year will enhance its oversight of plan marketing in numerous ways, such as through enhanced review of select marketing materials submitted under File and Use criteria, targeted oversight of MAOs and Part D sponsors with higher or increasing rates of complaints during the AEP, and review of recordings of agent and broker calls with potential enrollees, CMS said.

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2023 Stars Signal Return to Normal, With Some Caveats

A little over half of Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered in 2023 received an overall rating of 4 stars or higher, according to Medicare Parts C and D Star Ratings data released by CMS on Oct. 6. As expected, the new ratings reflect a return to normal after adjustments made for the COVID-19 public health emergency (PHE) resulted in a staggering 70% of MA-PD plans earning 4 stars or higher for 2022, compared with 49% of plans in 2021. But as the market becomes more saturated across the country, industry experts are watching closely to see whether recent steps taken by CMS to penalize poor performers will really level-set the market or demonstrate that more changes are needed to ensure members enroll in high-quality plans.

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As Expected, Top MA-PD Payers See Star Ratings Declines

The average star rating for Medicare Advantage Prescription Drug (MA-PD) plans declined following the phaseout of pandemic-related flexibilities, according to CMS. While 72% of MA-PD beneficiaries are enrolled in a contract that is rated at least 4 stars for 2023, that’s down from an all-time high of 90% in 2022. These drops were anticipated however, as CMS in 2022’s ratings qualified all contracts under an “extreme and uncontrollable circumstances” policy to account for the COVID-19 public health emergency (PHE), which allowed payers to pick “best of” scores on many measures. Also, for 2023, the agency assigned a greater weight to member experience measures based largely on contracts’ Consumer Assessment of Healthcare Providers and Systems, after CMS suspended the collection of CAHPS survey data during the PHE.

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Top Stars Performers Credit Coordinated Messaging, Targeted Outreach

As CMS resumed normal Star Ratings calculations and gave greater weight to patient experience measures, the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning 4 stars or higher for 2023 saw a dramatic drop from 2022, according to newly released CMS data. In an AIS Health series on successful Star Ratings strategies, top performers highlight connecting the dots around medication adherence, maintaining a year-round focus on member experience, and helping members navigate and utilize their benefits as key priorities. And while member outreach is a critical part of those initiatives, successful plans are careful to avoid overcommunicating with members and creating message fatigue, sources tell AIS Health, a division of MMIT.

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Number of Highly Rated PDP Contracts Shrinks in 2023

Only 9% of Medicare beneficiaries who sign up for a stand-alone Prescription Drug Plan (PDP) in 2023 will be in contracts rated 4 stars or higher, compared to 42% in the 2022 plan year, CMS recently estimated based on current enrollment figures. The average star rating for stand-alone PDP plans declined to 3.25 in 2023 from 3.70 in 2022, with only two PDP contracts receiving a 5-star rating. The change in distribution is largely due to adjustments in measure scores, and “the unusual circumstance of nearly all contracts qualifying for the regulatory adjustment for extreme and uncontrollable circumstances” driven by the pandemic, which led to higher than normal 2022 Star Ratings distributions, CMS explained in a fact sheet accompanying the release of the 2023 Star Ratings.

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Embedded ACO Pharmacists Produce Savings for BCBS of Rhode Island

While an unprecedented number of Medicare Advantage Prescription Drug plans earned a 5-star rating for 2022 largely because of flexibilities granted during the COVID-19 public health emergency, Blue Cross & Blue Shield of Rhode Island (BCBSRI) credits a performance-based pharmacist intervention model with dramatically improving its drug-related scores and contributing to a 5-star summary rating for both of its contracts.

For 2022, CMS allowed plans to use the better of the two years’ rating (2021 or 2022) for most measures because all contracts qualified for the “extreme and uncontrollable circumstances policy.” Plans will not have that flexibility for the 2023 star ratings due out this fall.

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News Briefs: HHS Predicts 15M Will Lose Coverage Once Medicaid/CHIP Redeterminations Resume

HHS is currently projecting that 17.4% of Medicaid and Children’s Health Insurance Program (CHIP) enrollees — or about 15 million people — will move out of those programs when the COVID-19 public health emergency (PHE) ends. States have been barred from conducting eligibility redeterminations for Medicaid and CHIP during the PHE, as a condition of receiving enhanced federal funding, but those eligibility checks will resume whenever the PHE ends. Of those expected to lose Medicaid/CHIP coverage, almost one third are expected to qualify for premium tax credits to help defray the cost of Affordable Care Act marketplace plans, and among those people, more than 60% can access a zero-premium plan.

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BCBSRI Achieved Savings, 5-Star Rating With Help of Embedded ACO Pharmacists

While an unprecedented number of Medicare Advantage Prescription Drug plans earned a 5-star rating for 2022 largely because of flexibilities granted during the COVID-19 public health emergency, Blue Cross & Blue Shield of Rhode Island (BCBSRI) credits a performance-based pharmacist intervention model with dramatically improving its drug-related scores and contributing to a 5-star summary rating for both of its contracts.

For 2022, CMS allowed plans to use the better of the two years’ rating (2021 or 2022) for most measures because all contracts qualified for the “extreme and uncontrollable circumstances policy.” Plans will not have that flexibility for the 2023 star ratings due out this fall.

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