Are You Aware of the 2021 Star Rating System Updates?

November 5th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Categories:   Medicare Advantage   Insurance  
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Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues: 

  1. Quality of Care 
  2. Cost 

In 2008, CMS implemented the Star Rating System, which scores each Medicare Part C (MA-PC plan) and Medicare Part D (PDP or MA-PD) on a scale of 1-5 stars, with a five-star rating identifying the highest performing plans and a one-star rating representing the lowest performing plans. Star ratings are awarded based on information about quality of care and cost obtained through data collection (e.g., claims, member records) and beneficiary surveys. Surveys of Medicare beneficiaries are done to gather information about their personal experiences with their current plan and healthcare provider on a range of issues, such as:  

  • Helping them stay healthy through screening tests, vaccines, and other check-ups that help monitor and improve their health 
  • Managing their chronic (long-term) conditions 
  • Interaction with the drug plan regarding patient education on the access to, use of, and safety related to prescriptions and other medications, and pricing information
  • Assistance provided by the plan to help the beneficiary disenroll (remove themselves) from the current plan 
  • Personal experiences while on the plan (e.g., complaints, assistance, provider and plan responsiveness, appeals) 
  • Customer service and communications with Part C and Part D 

Each year the Star Rating System goes through changes and updates, and the Centers for Medicare and Medicaid Services (CMS) published the 2021 Star Ratings on the Medicare Plan Finder on October 8, 2020. They identify the differences between the 2020 Star Ratings and the 2021 Star Ratings, which include:  

  1. Changed Measure Values: Replaced the 2021 Star Ratings measures that were calculated based on HEDIS and CAHPS data (using earlier values from 2020 Star Ratings, with a specific notation that “data collection was not affected by the public health threats posed by COVID-19" but rather used data HEDIS and CAHPS data from earlier 2020 Star Ratings compared to values from 2019 Star Ratings. 
    • Increased the weight of the following measures:
      • Patients’ Experience and Complaints Measures and Access Measures was increased to 2
      • Statin Use in Persons with Diabetes (SUPD) Measure increased to 3
      • Revised Plan Makes Timely Decisions about Appeals 
  2. Transition of a Measure (location)
  3. Retired Measures 
    • No measures were retired for the 2021 year

Often, plans that have higher ratings (4-5 stars) are those that have been contracted to offer Medicare Advantage plans for several years and consequently provide a greater experience overall in managing plans and meeting the needs of the beneficiary. New plans, on the other hand, often have the lowest ratings for the first year, which increase as they learn to manage and market the plan offerings and address the key issues that matter most to beneficiaries. While there are many factors that make up the star-ratings, all in all, they are vital to successful Medicare Advantage and Prescription Drug plans. These ratings are important and any plan that simply states the ratings do not matter should really take a closer look at the impact they have on beneficiary choices. Plans that focus on the two issues of quality of care and costs are more likely to attract and retain beneficiaries. However, keeping them year after year requires strategic planning to ensure the expectations of quality of care and low costs are met.  

For additional information on the changes and updates to the 2021 Star Ratings system, see "The Fact Sheet – 2021 Part C and D Star Ratings" and "Medicare 2021 Part C & D Star Ratings Technical Notes," available through these links.  

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