2021 Medicare Star Ratings: By the Numbers
Each October, the Centers for Medicare & Medicaid Services (CMS) publishes star ratings that measure the quality of plans’ health and drug services and the experience the plans provide to members.
Along with the 2021 star ratings, CMS provided a fact sheet detailing how the market performed, how it is trending and gave a nod to the five-star plans that received the high-performing indicator on Medicare Plan Finder. Whether your plan is happy with your overall performance or is looking for ways to improve, the 2021 scores provide a path forward.
Trends in 2021 Part D Star Ratings
While the fact sheet highlights overall market trends, our analyses include some additional angles, such as comparing Part C to Part D summary scores. In reviewing the data, we found:
- The number of plans that performed higher on Part D (drug coverage) than on Part C (Medicare Advantage) fell by 33% from 2020 to 2021 after remaining almost constant from 2018 to 2020.
- When we looked at the average scores for Medicare Advantage Plans that include drug coverage (MAPD plans), we saw a decline (often small) from 2020-2021 across nine of the Part D measures, including all four adherence metrics.
- The market saw an increase in plans with a Part D summary that was lower than their overall rating.
- The percentage of members enrolled in MAPD plans that achieved a score of 4 to 5 stars on the Part D summary rating decreased by more than 20%.
While pharmacy benefit managers (PBMs) can partner with health plans on Part C (Medicare Advantage) and Part D (drug coverage), the partnership has the most visible influence on the Part D side. These statistics highlight opportunities for increased partnership between Health Plans and PBMs to drive improvement on the Part D summary score.
Express Scripts is proud that 88% of the MAPD membership we support resides in 4-5 star Part D plans – a figure 25% higher than the industry’s average.
Addressing Future Star Ratings
While CMS’s long-time commitment to beneficiary protection is well documented, star ratings have focused even more in recent years on beneficiary experience. Today, those metrics, referred to as Consumer Assessment of Healthcare Providers and Systems (CAHPS), carry a weight of 1.5 when computing a plan’s star rating. By 2023, the metric’s weighting will increase to 4, contributing to 60% of the final rating for all Medicare plans.
This increased weight needs to be addressed diligently, as it has the potential to impact a plan’s overall performance, specifically if they are struggling with member experience today. An internal analysis showed that if all other aspects are held constant, this increased rating would lead to a declined rating in roughly one fourth of all plans.
Plans who are struggling with CAHPS measures should consider investing in more “controllable” measures with high weights, such as adherence, as a way to anchor their overall performance while offsetting some of the risk of the increased CAHPS measures.
Plans can also capitalize on this increased weighting by their approach to member interaction. At a recent Express Scripts Regulated Markets Summit, one plan shared how it is partnering with Express Scripts on a “white glove” experience of personalized customer service and support that helps members during the process of getting set up to getting their medications and beyond.
Plans should also consider:
- Having a firm grip on display measure performance – measures that are not currently part of the overall star rating but likely could be in coming years
- Continuously commenting to CMS about tweaks to regulations, including Categorical Adjustment Index metric inclusion – statistical adjustments that account for the impact of socioeconomic status and disability prevalence within a Medicare population, removal of several low weight or high performance metrics and new MPF Medicare Plan Finder composite scoring – CMS’s plan comparison tool
- Evaluating their strategy and risk if they anticipate impact from the increased weight given to member experience, complaints and access
This year, like no other, has yielded uncertainty but has opened up new opportunities for plans to think beyond the status quo. By leveraging partners, like PBMs, to help approach strategies differently, plans can create a strategy to address the need now for higher weights in order to see returns in the future.