A Kaiser Family Foundation report notes that for 2022, the average Medicare beneficiary has access to 39 Medicare Advantage plans. That's a figure more than double the number of plans per person available in 2017. It's also the largest number of options available in more than ten years. Nearly 4,000 Medicare Advantage plans are available nationwide in 2022, representing an 8 percent increase from 2021.As health plans work to distinguish their Medicare Advantage offerings from an increasing number of competitors, the importance of Medicare Advantage star ratings has grown, as have each of the measures that influence a plan's score (i.e., star rating). In addition to enrollment implications, Medicare Advantage star rating performance has a direct financial impact on health plans.
Let's take a brief look at why Medicare Advantage star ratings have taken on such significant importance for health plans, focusing on two areas with the potential to greatly influence a plan's Medicare Advantage star rating performance.
Overview of Medicare Advantage Star Ratings
The Centers for Medicare & Medicaid Services (CMS) implemented Medicare Advantage Star Ratings in 2007. The purpose was essentially two-fold:
- The star-rating system can better inform Medicare beneficiaries about the quality of their Medicare Advantage plan options and help them make a more educated decision about the plan section.
- The star-rating system has quality bonuses tied to Medicare Advantage plan performance. In other words, plans with higher star ratings can earn more money.
As a McKinsey & Co. report states, "Plans awarded four or more stars earn a five percent bonus on CMS payment benchmarks, as well as higher rebates to use toward richer supplemental benefits for members."
Medicare Advantage plans are rated on a one-to-five-star scale, including half-point ratings (e.g., 1.5, 2.5) as possible scores. One star represents poor performance, while five stars represent excellent performance. Where do these stars come from you may ask? They're determined based on the experiences of Medicare beneficiaries enrolled in Medicare Advantage and Part D prescription drug plans. These experiences correspond to specific measures upon which health plans are rated.
For 2022, Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. MA-only contracts (i.e., those without prescription drug coverage) are rated on up to 28 measures. Standalone prescription drug plan contracts are rated on up to 12 measures. More specifically, as The Commonwealth Fund notes, these measures assess whether Medicare Advantage enrollees receive appropriate preventive care and how well their chronic diseases are controlled. The composite star-rating score is published on the Medicare Plan Finder website. It includes administrative measures (e.g., a plan's timeliness in responding to coverage decision appeals) and enrollees' plan ratings.
Understanding Star Ratings for Transitions of Care and Medication Reconciliation Post-Discharge
Two areas of significant importance to a health plan's Medicare Advantage star rating are transitions of care (TRC) and medication reconciliation post-discharge (MRP). Prior to 2022, CMS was measuring a health plan's success concerning medication reconciliation through a single MRP quality measure. That changed for this year. CMS is now requiring that Medicare Advantage plans report on the Healthcare Effectiveness Data and Information Set (HEDIS®) "Transitions of Care" (TRC) measure that will be used to generate the 2024 Medicare Advantage star ratings.
HEDIS® TRC Measure Explained
What does the HEDIS® TRC measure have to do with medication reconciliation post-discharge? As discussed in this blog post, MRP is one of the TRC measure's four reported rates, with the others being notification of inpatient admission, receipt of discharge information, and patient engagement after inpatient discharge.
Through its decision to move away from MRP as a standalone measure and toward the HEDIS® TRC measure, CMS seems to be placing great emphasis on the importance of transitions of care and, within them, the crucial role of medication reconciliation post-discharge. Consider that MRP on its own encompasses two of TRC's reported rates:
- Patient engagement after inpatient discharge.
By moving to the TRC HEDIS® measure, CMS added two additional focus areas.
We frequently highlight statistics demonstrating how important it is for many patients to receive MRP. It is estimated that 40 to 50 percent of discharges do not include an MRP, more than one in four patients have an adverse drug reaction post-discharge, and about one in five patients are readmitted due to adverse drug reactions.
CMS notes that transitions of care increase the risk of adverse events due to the potential for miscommunication. As responsibility is passed along between parties, hospital discharge is a complex process representing a period of significant vulnerability for patients, with one such vulnerability concerning medication risks.
Research showed that "More than 40% of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients."
Improving Medicare Advantage Star Ratings Performance: What Health Plans Should Do
Health plans that hope to improve or at least maintain their Medicare Advantage star ratings and reap any associated financial rewards must prioritize efforts around transitions of care and medication reconciliation post-discharge. Improvements in these areas that contribute to stronger Medicare Advantage star ratings can help health plans expand their number of Medicare Advantage enrollees and increase their quality bonus payments. KFF notes that in 2021, more than 26 million Medicare beneficiaries were enrolled in a Medicare Advantage plan, a figure expected to grow in the years ahead.
Unfortunately, improving TRC and MRP is often easier said than done for health plans and provider organizations because there are so many patients who would benefit but not enough staff and time to consistently, properly, and effectively perform MRP. This ultimately leads to missed MRPs and errors, contributing to higher readmissions and lower star ratings.
Enter Cureatr's MRP service. Through the Cureatr Clinic, our team of clinical pharmacists, supported by advanced technology and unmatched patient data access, provides health plans and provider organizations with the medication experts needed to provide MRP and additional medication management and care coordination services. The results: Patients get the medication-related services they need to keep them on their treatment path and away from a return visit to the emergency room. To learn more, request a consultation!