CMS Medicare Advantage 2022 Star Ratings - AHIP
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2022 MA Stars Analysis CMS Medicare Advantage 2022 Star Ratings Comprehensive market analysis of CMS MA 2022 Star Ratings to uncover insights and upcoming industry shifts that are likely to shape future Stars strategies This whitepaper represents the views of the author, not AHIP. The publication, distribution or posting of this whitepaper by AHIP does not constitute a guaranty of any product or service by AHIP.
www.citiustech.com
2022 Star Ratings Performance Objectives
Analysis
CMS released the 2022 Star Ratings for the • Get a detailed retrospective Stars
Medicare Advantage program in October performance analysis
2021. CitiusTech’s latest report on Star
Ratings performance provides an industry- • Identify focus areas for actionable
wide perspective around Star ratings released planning
for 2022 and compares them to the prior
• Inform Stars performance challenges
year’s ratings. for 2023 and beyond
This analysis is geared to provide holistic
insights to business, consulting and
technology stakeholders who are actively
involved in improving MA Star Ratings. It
helps them to strategically position
themselves and modify their initiatives for
Stars improvement.
1Highlights for 2022 Stars
Historic rise in the enrollment of high performing Medicare Advantage Prescription Drug
1 Plan (MAPD) and Prescription Drug Plan (PDP) contracts
MA contracts with less than 50,000 enrollments, drive significant Year-on-Year
2 improvement towards high Stars performance
Additional data points from newer contracts is resulting in a significant improvement in
3 the Member Experience performance
A significant rise in Year-on-Year performance across highly weighted data sources is
4 the primary cause for high Stars improvement
Measure-level improvements across 4 Stars and above rated contracts were driven by
5 pandemic relaxations and minimum threshold changes
2Historic rise in the enrollment of high performing MAPD and PDP
1 contracts
YOY Distribution of MAPD vs Medicare FFS Key Statistics
Beneficiaries
• 9 out of 10 MAPD enrollees are part of 4 Stars and
Year 2021 Year 2022 above rated contracts; ▲ 14% YOY rise in enrollee
distribution across high-rated contracts
38.4 37.6 ▼ 2.2%
▲ 9.2% • 75% of high rated MAPD enrollments fall under
23.1 25.2
contracts with > 50K enrollees
• ▲ 2% YOY growth of overall Medicare enrollees (MA +
Medicare Fee For Service (FFS)) 1.26M
MA Beneficiaries Medicare FFS Beneficiaries (In
(In Millions) Millions)
• ▲ 9% increase in MAPD enrollment between 2021-22
(2.12 M) as compared to the ▼ 2% drop in Medicare FFS
2021 vs 2022 Enrollment Distribution by Our Perspective
Stars
• Historic rise in high Star rated contracts with quality
2021 Enrollment 2022 Enrollment bonus eligibility will cause MA market to have
competitively priced supplemental benefit options
50%
Distribution %
40%
• Disproportionate enrollee distribution across higher than
30%
4.5 Stars contracts reflects consumer affinity for
20%
supplemental benefit offerings
10%
0%
• Primary deterrents for member disenrollment are – lack
Less Than 4 4 Stars 4.5 Stars 5 Stars
of clarity around drug and medical benefits, along with
Stars
difficulty in accessing health plan information
3MA contracts with < 50K enrollments, drive significant YOY
2 improvement towards High Stars Performance
MAPD Distribution by Contracts YOY Key Statistics
Less than 4 Stars 4 Stars 4.5 Stars 5 Stars • ▲19% rise in MAPD Contracts with 4 Stars and above in
2022 (i.e. 322 in 2022 vs. 195 in 2021)
31.6%
YEAR 2022 15.7% • 51% MAPD contracts (with 3+ years existence) reported
20.4% improved performance in 2022 vs 2021
32.3%
51.3% • 88% of large size MAPD contracts have scored high Star
YEAR 2021 5.3% ratings compared to 63% in small size segment
16.0%
27.5% • 80 newly rated MAPD contracts in 2022 contributed
for ~18% rise in MAPD contract base YOY
MAPD Contracts by Enrollment Size and Performance
Our Perspective
• Industry performance has improved due to COVID
exception policies and additional reported data points
from new contracts
• Steady shift of rising MA population across high
performing contracts will be a driving factor for CMS
strategy recalibration for benchmarks
• With ~$57 PMPM increase in bonus rates across all
bonus categories (0%, 3.5%, 5%), the earning potential
to score 4 Stars and above increased by 50%, driving
expansions, acquisitions and new entries
4
Note: The variance is the difference in distribution of 4 Star contracts between 2022 and 2021Additional data points from newer contracts is resulting in a significant
3 improvement in the Member Experience performance
YOY Variance Distribution of 4 Stars and above contracts Key Statistics
by Domain
• ▲ 17% shift in contract distribution with high Stars for
DD3: Member Experience with the Drug
member experience domain DD3; ▲ 13% shift for HD3,
Plan
17% DD4
• ▲ 3% rise in contract distribution with high Stars for
HD3: Member Experience with Health Plan 13% operational domains. 90% contracts scored 4 Stars and
above
DD4: Drug Safety and Accuracy of Drug
12%
Pricing • 58% contracts have unreported Stars for the applicable
domains; half of the unreported Stars are attributed to
HD2: Managing Chronic (Long Term) new contracts
8%
Conditions
• 25% YOY increase in reporting data points for
HD1: Staying Healthy: Screenings, Tests and
6% operational domain DD1
Vaccines
Our Perspective
HD5: Health Plan Customer Service 6%
• A 2X weightage shift across member experience
domains and inorganic 2022 Stars growth presents an
HD4: Member Complaints and Changes in
3% uphill task for MA contracts to maintain 4 Stars & above
the Health Plan's Performance
• Increased budgets via 2022 bonuses to fuel focused
DD1: Drug Plan Customer Service 3% investments across modern technologies to improve
member experience and drive provider performance
DD2: Member Complaints and Changes in
1% • Enhanced focus on future expansion of value-based
the Drug Plan’s Performance
payments as a part of the MA network strategy for
driving higher Stars at optimized cost
5
Note: The variance is the difference in distribution of 4 Star contracts between 2022 and 2021A significant rise in YOY performance across highly weighted data
4 sources is the primary cause for high Stars improvement
2022 % Distribution contracts across 4 Stars and above Key Statistics
% Contracts with 4 Stars and above % Contracts with less than 4 Stars
• ▲ 10% - 28% YOY increase in high performing contracts
0% 20% 40% 60% 80% 100% across CAHPS (2X); Stars Ratings (5X)
CTM • 80% of contracts that scored 5 Stars in both years were
also seen to have consistently high (over 90%) YoY
IRE performance for CTMs
Call Center • ▼ 27% YOY decrease for PDE/MPF data source led by a
▼ 56% reduction in 5 Star contracts compared to 2021
Part D Reporting
MBDSS
Our Perspective
PDE / MPF Pricing
• Reduced complaints, owing to lower elective procedures
HEDIS and deferred care, have largely driven performance for
CTM, IRE and Call-Center
Star Ratings
• 2023 Stars that will be based off 2021 survey data will
Part C Reporting demonstrate the pandemic’s impact on member
experience and care access with virtual provider
CAHPS interactions
PDE Data • With member experience as the key focus for 2023,
advanced segmentation, specialized care management,
HOS digital collaboration and member journey analytics will
be key areas for active payer investment
6Measure-level improvements across ≥ 4 Stars rated contracts were
5 driven by pandemic relaxations and minimum threshold changes
Top 6 measures based on Cut-point Change and Performance Key Statistics
Improvement
• ▲16 - 29% YOY increase in high performing contract
distribution for statin therapy utilization, breast cancer
2022 Weights (Change)
YOY Cut-point Change
screening, C&D improvement measures and medication
Reported Data Point
High Rated Contract
Distribution Change
adherence for RAS Statins
Data
Measure Name • ▼ 16 - 26% YOY decrease in high performing contract
Source
distribution for HOS measures, medication adherence
for diabetic meds and MPF price accuracy
Change
• 3 - 5% cut-point shift through CMS guardrail modelling,
D04: Drug Plan Quality Star ▼ 15% - 30% sensitivity is observed for high rated
5 (-) 10% 9% 29% contract distribution across most measures
Improvement Ratings
D09: Medication Adherence for
Hypertension (RAS PDE 3 (-) 0% 12% 26% Our Perspective
antagonists)
• With office visits & utilization getting back to pre-COVID
C25: Health Plan Quality Star - levels, clinical/operational measures extend the
5 (-) 7% 26%
Improvement Ratings 19% opportunity to build a stronger foundation for Stars
C16: Statin Therapy for
Patients with Cardiovascular HEDIS 1 (-) 1% 22% 21% • 2022 improvement across all member experience
Disease measures, driven by minimal change in cut-points,
increased weightage and stiff market competition
C01: Breast Cancer Screening HEDIS 1 (-) -9% 20% 19%
D10: Medication Adherence for
• With FHIR interoperability and clinical data exchange
Cholesterol (Statins)
PDE 3 (-) 1% 11% 16% going live by Jan 2023, seamless clinical data
availability can significantly improve year-round
coordination for higher Star outcomes
72022 Star Ratings Analysis: Focus Areas for 2023
30% (▲ 6%) contribution of CAHPS with 2X weightage shift
1
• Adoption of PROM (Patient Reported Outcome Measures) surveys and member portals
• Disease specific care management with focus on digital member engagement
CMS Guardrail to be launched for Stars 2023
2
• Most contracts showing high sensitivity for 3-5% cut-point shift
• Highly precise forecasting capabilities & ‘what-if’ simulations for guided Stars improvement
Payer-provider clinical data exchange on FHIR to go-live by Jan 2023
3
• Implementation of bidirectional Payer-Provider clinical data exchange strategies using FHIR
• Stronger year-round coordination for high Star performance across clinical measures
100% provider payments in MA through alternate payment models by 2025 (1)
4
• Steady transition to value-based models to counter more stringent benchmarks
• Recalibration of sub-network strategies for optimal Star outcomes through market expansion
8
1- http://hcp-lan.org/workproducts/2021-Roadshow-Deck-508.pdfAbout CitiusTech
CitiusTech (www.citiustech.com) is a leading provider
of healthcare technology services, solutions and platforms
to over 120 organizations across the payer, provider,
medical technology and life sciences markets. With over
5,400 technology professionals worldwide, CitiusTech
5,400+
healthcare IT professionals
powers healthcare digital transformation through next-
generation technologies, solutions and accelerators. Key
focus areas include healthcare interoperability & data
management, quality & performance analytics, value-based $300M+
care, omni-channel member experience, connected health, worldwide revenue
virtual care coordination & delivery, personalized medicine
and population health management.
CitiusTech has two subsidiaries, FluidEdge
120+
healthcare clients
Consulting (www.fluidedgeconsulting.com) and SDLC
Partners (www.sdlcpartners.com) with deep expertise in
healthcare consulting and payer technologies, respectively.
CitiusTech’s cutting-edge technology expertise, deep 70+
healthcare domain expertise and a strong focus on digital NPS - highest in the industry
transformation enables healthcare organizations to reinvent
themselves to deliver better outcomes, accelerate growth,
drive efficiencies, and ultimately make a meaningful impact
to patients.
9CitiusTech Key Contacts
Shitang Patel Prosenjit Dhar Harsh Desai
Asst. Vice President Sr. Healthcare Consultant Healthcare Consultant
Payer Market Payer Market Payer Market
CitiusTech CitiusTech CitiusTech
Shitang has 20 years of experience Prosenjit has 13 years of Harsh has 9+ years of experience
spanning healthcare management experience in the payer Industry in US Health Analytics across
and health policy making settings, for large IT services organizations payer and provider market. Prior
with focus on payer strategy and across market research and pre- to CitiusTech, he worked for
business transformation. Prior to sales, product consulting and several large payers and led
CitiusTech, he worked for PwC product management. successful end-to-end
Health Industries Advisory for 9 development/implementations of
years, and health services research He is AHIP Certified and has various value based and HEDIS
and policymaking in Washington specialized for payer quality analytic solutions.
D.C. for 5 years. (HEDIS/Stars), FWA, payer core
administration with focus on He holds a Masters in Healthcare
Specialty areas include: payer- platform solutioning and sales. Administration and is Six Sigma
provider integration and Green Belt Certified.
contracting, consumer-centric Prosenjit’s current focus areas
operations, analytics and data Specialty areas include: value
include HEDIS/Stars, quality and
science, Stars and quality based contracting, network
data management platforms.
improvement, core admin system management, claims systems,
evaluation and selection, value- HEDIS/Stars, business intelligence
based insurance design and and analytics.
financial reporting.
Email Shitang at: Email Prosenjit at: Email Harsh at:
shitang.patel@citiustech.com prosenjit.dhar@citiustech.com harsh.desai@citiustech.com
9This document is confidential and contains proprietary information, including trade secrets of CitiusTech. Neither the document nor any of the information contained in it may be reproduced or disclosed to any unauthorized person under any circumstances without the express written permission of CitiusTech. Copyright 2021 CitiusTech. All Rights Reserved. www.citiustech.com
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