Quality performance metrics such as HEDIS and Medicare Advantage Star ratings offer consumers an indication of healthcare payer quality. The 2022 Star ratings saw increases in national averages across many measures. As COVID-19 will have less of an impact on 2023 and 2024 Star ratings, they will more accurately reflect the CMS’s mission to improve patient experiences and outcomes.

Here are some important upcoming changes to Star ratings and how health plans can prepare for them.

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Reducing the weight of Patient Experience/Complaints and Access Measures

In the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage (MA) Program document released in December 2022, CMS has proposed to decrease the weight of Patient Experience/Complaints and Access measures from four times to two times for the 2026 Star Ratings [1]. This update would reverse the previous increase that was implemented for the 2023 Star Ratings, which led to these measures comprising 58% of a plan’s overall rating. Although these measures play a key role in critical aspects of care such as care coordination and access, the CMS has stated that these measures currently receive an undue weight in the Star ratings program.

If implemented, 16 measures would lose half their weight, which is especially significant as Medicare Advantage (MA) plans have invested time and resources into these qualitative measures in the past several years. While it would be a significant change, it offers an opportunity for plans to shift their focus to keep up with the new quantitative and qualitative CMS measures.

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Reporting against the Kidney Health Evaluation Measure

The National Kidney Foundation (NKF) partnered with NCQA to develop the Kidney Health Evaluation for Patients with Diabetes (KED) as a new measure in the Healthcare Effectiveness Data and Information Set (HEDIS®). This new measurement is in place with the goal of improving the rate of testing for CKD among people with diabetes. Public reporting of the KED HEDIS measure will begin in late 2023.

The KED measure aims to grow the percentage of adult health plan members/patients with either Type 1 or Type 2 diabetes who received a guideline-concordant Kidney Health Evaluation comprising an estimated glomerular filtration rate (eGFR) blood test and an albumin-creatinine ratio urine test (uACR) during the measurement year. Plans should prepare to report against the Kidney Health Evaluation Measure for the STAR ratings system since it will help Medicare measure quality performance and help consumers compare the quality of competing plans.

Advancing health equity

In order to advance health equity for all, including underserved and marginalized populations, the CMS is clarifying current rules and finalizing the Health Equity Index for the 2025 measurement year will be based on performance in both MY2024 and MY2025.

Low digital health literacy, continues to prevent people from accessing telehealth and worsen care gaps, especially among populations experiencing health disparities. To address this, the CMS is finalizing requirements for MA organizations to offer digital health education to enrollees and improve care access. Additionally, the CMS is improving current best practices by requiring MA organizations to include providers’ cultural and linguistic capabilities in provider directories. Finally, CMS is requiring that MA organizations’ quality improvement programs include efforts to reduce disparities. Investing in changes will help MA plans gain a competitive advantage with future Star Ratings and quality bonus payments.

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  1. https://www.federalregister.gov/documents/2022/12/27/2022-26956/medicare-program-contract-year-2024-policy-and-technical-changes-to-the-medicare-advantage-program