Centers for Medicare & Medicaid Services (CMS) released the 2023 star ratings for Medicare Advantage, and Part D plans to help people compare options for Medicare 2023 open enrollment. Medicare star ratings reached record highs in 2022 due to COVID-19-triggered changes to star rating calculations. However, the removal of pandemic regulatory flexibilities and the addition of new measures has resulted in the overall average rating for Medicare Advantage plans falling from 4.37 stars to 4.15 stars for 2023 [1]. CMS announced that only about 51% of Medicare Advantage (MA) plans offering drug coverage will have a star rating of four or more in 2023, compared to 68% of plans with such a rating or higher in 2022 [2].

Here’s what to know about 2023 star rating changes and what health plans can do to maintain and improve their quality ratings in the future.

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2023 Star Rating Changes

CMS regularly revises its star rating system, so it’s not uncommon to see changes from year-to-year. 2023 star rating averages are on par with 2020 and slightly higher than 2021 before the disaster policy made the scoring more lenient for 2022. These findings suggest that 2023 rating declines are mostly a result of behind-the-scenes scoring changes.

Still, declines in star ratings pose serious financial implications that directly impact member benefits and member retention. It is crucial for health plans to adjust for new measures that will have a greater impact on star rating scores, such as health equity and ratings of healthcare quality. Here are two strategies health plans can use to maintain or improve quality scores for plan growth, retention, and financial health in the future.

1. Create an Organizational Culture of Quality

The U.S. spends more money per person on healthcare than any other nation in the world, yet Americans often do not get the care they need. Only about 8% of U.S. adults receive all of the high-priority, appropriate preventive care recommended [3]. Preventive care is underused, resulting in higher spending on complex, advanced – and often preventable – diseases such as hypertension, heart disease, and diabetes.

A quality-based model requires health plans to be accountable for the health of their member populations, and many HEDIS measures are designed to urge health plans to focus on the prevention and early detection of chronic disease. A preventive approach represents a significant paradigm shift from the traditional healthcare model, in which member interactions are typically based on specific health episodes. To improve quality, health plans must focus on maintaining the health of their populations, in addition to effectively treating those with acute or chronic conditions.

2. Focus on Health Equity

Since health plans are rated on how often members with long-term conditions get certain tests and treatments that help manage those conditions, health plans serving populations with a high incidence of chronic disease may have a harder time maintaining high ratings. The chronic disease burden is concentrated among lower-income populations, with chronic disease tending to go unmanaged in these patients. To help close gaps in care, CMS has proposed a new health equity index to enhance the star rating system. This index will collect more data on beneficiary race, ethnicity, and social determinants of health (SDOH).

Focusing on quality improvement initiatives for lower-income populations can help health plans address significant gaps in care and improve star ratings. Increasing equitable access to quality care is crucial since there is a significant shortage in access to primary care in lower-income neighborhoods across America. Leveraging innovative care methods, such as at-home tests, can be an effective and affordable solution for increasing screening rates in disadvantaged populations.

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How LetsGetChecked Can Help

LetsGetChecked’s powerfully-accessible healthcare solutions can help health plans close care gaps, increase member engagement, and improve quality ratings. From at-home testing to pharmacy services and virtual consultations, our solutions meet your members where they are to provide them with equitable access to quality care. Together, we can better engage and support members and drive improvements in patient outcomes and star ratings alike.

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