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What You Need to Know About CMS'​ Recent Flurry of MA Star Ratings Reports, Data and Notifications

Yesterday evening CMS released a number of key documents for Star Year 2022 and 2023 including a last-minute announcement that the two, triple weighted HOS outcomes measures will be moved to the display page effective Star Year 2022 and 2023 due to validity concerns caused by the COVID-19 PHE. Additional information about this announcement can be found here.

This announcement was closely followed by the release of the following HOS reports:

2018-2020 Cohort 21 Medicare HOS Performance Measurement Report:

  • Based on data from the MA HOS 2018, Cohort 21 Baseline and 2020 Cohort 21 Follow Up surveys.
  • Includes information on HOS measures used in the MA Star Ratings.
  • Includes member demographic data that could be helpful in analyzing contract-specific COVID-19 PHE impact to HOS outcomes.

2018-2020 Medicare HOS Cohort 21 Star Ratings Validation Report:

  • Includes both display and Star Ratings measures from the 2018 Cohort 21 Baseline and 2020 Cohort 21 Follow Up surveys, including three HEDIS HOS measures included in the 2022 Star Ratings, and four measures for the display page (which now includes Improving or Maintaining Mental Health & Improving or Maintaining Physical Health).

HOS Aggregate Score Analysis, and 2020 Round 23 HEDIS HOS Report:

  • Averages Cohort 21 Baseline and Follow Up scores at the contract, state, region, and national levels for several core physical and mental health outcome measures and other HOS indices of functional health status.

MA plans also received their 2021 MA PD CAHPS survey results for Star Year 2022 yesterday, including adjusted measure rates, updated cut points and resulting measure Stars. Note that the 2022 Star Ratings will incorporate adjustments for Extreme and Uncontrollable Circumstances (EUC) as applicable, which will be available during the second CMS plan preview.

A significant, across-the-board upswing in CAHPS cut-points came as an unpleasant surprise to many health plans that were counting on COVID-outreaches and the resulting CAHPS improvements to get them over the four-star finish line! Of the 36 total CAHPS cut-point thresholds only 2 decreased, one being the single weighted Annual Flu Vaccine measure with a 1 point decrease at the 2-star threshold, and Getting Needed Care also decreasing by one point at the 2-star threshold. All other cut points for the remaining CAHPS measures either maintained (12) or increased (22!!), bringing the CAHPS cut-point thresholds even higher and tighter when compared to prior years. For the majority of CAHPS measures, an improvement or decline of only one or two points can now lead to a one to two Star Rating change!

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The “grand-finale” for the day though, was the release of Star Year 2022 First Plan Preview data. Per CMS, plans have until August 16th to closely review the methodology and their posted data in HPMS for each measure.

With all of the changes exclusive to this Star Year creating the possibility of numerous plans reaching out to CMS with rebuttals, requests, and questions, we advise that plans make an extra effort to promptly notify CMS of any suspected data issues or errors in order to allow sufficient time to investigate and process any necessary data corrections. Although we do not yet know the impact that cut-point changes will have on the majority of measure Star Ratings, having the actual measure rates in hand brings plans a step closer to applying the EUC’s “greater-of” logic to applicable measures and calculating the projected impact this will have on their overall plan rating.

I foresee a weekend filled with coffee, spreadsheets and Zoom meetings with Star Rating’s clients, connections and colleagues!

Also published on LinkedIn, here.