CMS’s Oct. 6 release of the 2023 Medicare Advantage (MA) Star Rating calculations show a decline in plan performance on numerous measures resulting in only 51% of plans receiving a quality bonus for being ranked 4 stars or higher (down from 67% in 2022).
It should be noted that during the pandemic MA plans’ overall quality ratings were protected from decreasing due to the COVID-19 public health emergency. Only three measures were adjusted for COVID-19 impacts in the 2023 MA Star Ratings. CMS also updated its total star rating calculation by doubling the weight of consumer surveys (CAHPS) so it now accounts for one-third of the total Star rating.
The 2023 results indicate that of the 23 non-drug related MA measures, MA plans’ performance declined on all but 6 measures. In particular, on four measures — improving bladder control; reducing risk of falling; call center – Foreign Language Interpreter and TTY availability; and notably, Members Choosing to Leave the Plan — plans declined by more than 2 points. The first two of these measures may be areas where aging service providers can help plans improve their scores, and might prove an opportunity for LeadingAge members to approach the plan about a value-based payment arrangement in their contract with these plans.
MA Star Ratings impact a plans ability to achieve bonus payments of up to 5%, to retain higher percentages of rebate dollars that are used to cover supplemental benefits for their enrollees; and their ability to enroll Medicare beneficiaries year-round. In 2023, 20% of plans will lose their bonus payments due to these changes to their ratings. CMS also notifies MA enrollees when they are enrolled in a plan that is less than 4 stars and a 4 star or higher plan is available to them. 57 MA-Part D plans will receive a “high performing” icon for earning 5 stars. CMS finds that non-profit plans “more frequently earn higher ratings than organizations that are for-profit” and typically, “higher overall Star Ratings are associated with contracts that have more experience in the MA program.”
The CMS update of quality data arrives timely with Open Enrollment for Medicare Advantage and Special Needs Plans beginning October 15 and running through December 7 for the 2023 plan year. Plan Star Ratings are included on the Medicare Plan Finder tool at www.medicare.gov. For more details on CMS’s MA Star Ratings, the 2023 Medicare Advantage and Part D Star Ratings Fact Sheet can be accessed here.