Key takeways for practice success in 2023 stars performance

by Michael Jones

You as a primary care leader are responsible to your practice and yourself for financial performance.  As value based care evolves for your Medicare patients, this performance is becoming more directly linked to stars performance. There are value based care programs available from CMS directly, as well as payer-specific value based care incentives that your practice might qualify for. There are also basic, upside-only contracts from both entities and more advanced, risk-bearing contracts as your practice matures and can gain through these more advanced contracts. 

We’ll explore some differences in the basic and risk-bearing models in future articles as well as how to maximize your performance in each. Today, we’ll share some focus areas in star ratings for measurement year 2023, and show you what these changes mean to you as a thought leader in primary care.

As a primer, the star ratings cycle has a two year lag between the performance period and the rating period. Measurement period for 2022 star ratings (published by CMS in October 2022), is based primarily on data and activity from 2020. Health plans are measured at a contract level, which may span multiple states or even a subset of counties within a state. 

Your current practice performance data that is shared with your practice is based on actual performance (typically  total patients in the measure divided by the number of compliant patients) compared to predicted cut points for star rating levels in that measure. Health plans often include language in incentive contracts to address these changes in cut points, and will have a mid to late year adjustment of cut points based on CMS data vs predictive data.

As stated by the Medicare Star Ratings Fact Sheet, published in October 2022, there are several noteworthy updates that will have a direct impact on your practice. We’ll focus on two of them.

Guardrails were instituted to limit cut point movement

The Medicare Star Ratings Fact Sheet specifically states “Guardrails were introduced in the 2023 Star Ratings for all measures that have been in the Part C and D Star Rating program for more than three years except the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Part C and Part D improvement measures. Guardrails are bi-directional caps that restrict upward and downward movement of a measure’s cut points for the current year’s measure-level Star Ratings compared to the prior year’s measure-threshold specific cut points”. These guardrails prevent cut points for non-CAHPS measures from moving greater than 5% in either direction.

Why does this matter to your practice?

Health plans rely on both external sources for data validation, such as Acumen for pharmacy predictions, and internal quantitative modeling. The guardrails will both offer more predictability in planning for future cut points and will safeguard against catastrophic swings in either direction. For you at the practice leadership level, this will hopefully mean less year-end surprises for cut point changes, and it will also underscore your internal processes for maximizing performance. 

Success in star ratings performance is to some degree a math problem, in that analyzing your current total members in each measure compared to compliant members can give you a mathematical path to stars success. The cautionary tale is to not simply manage to a finite number based on cut points. Striving for 100% adherence, true “best in class” performance, will always be the path to maximum success. Introducing cut point guardrails will likely help you monitor your success as the year goes by, and do so in a more predictable manner.

Member satisfaction scores are now quadruple rated

Again according to the Medicare Star Ratings Fact sheet, “The weight of patient experience/complaints and access measures increased from 2 to 4 for the 2023 Star Ratings”. While the overall impact of this move is predicted to be favorable, health plans have seen an overall decline in CAHPS performance in 2022. Getting Needed Care, Getting Appointments and Care Quickly, Rating of Health Care Quality, and Care Coordination (practice level) and Customer Service and Rating of Health Plan (health plan level) all saw a decline in the March through June 2022 patient surveys.

Why does this matter to your practice?

You’ve likely learned of measures and weighting of measures, often with a nod toward the triple weighted medication adherence measures. Final success for your practice and for the health plan cannot be achieved without performing well in these highly weighted measures, and now these member satisfaction scores have become quadruple weighted. 

Having a plan for the patient experience, using CMS compliant language and methods, will be even more important than ever. Do you have a plan and a policy for your patients to get appointments quickly? Do you have a way to gauge how long patients wait in your office before being seen by a clinician? Do you have ways to address patient concerns? Plan proactively so that your practice can maximize your success in these quadruple weighted measures now.

At the measure level, medication adherence and cancer screenings are noteworthy. Nationally, performance in Medication Adherence for Cholesterol (Statins) and Medication Adherence for Diabetes Medication declined, while Statin Use in Persons With Diabetes and Medication Adherence for Hypertension (RAS Antagonists) improved, and performance in both Colorectal Cancer and Breast Cancer Screening declined. Approaching these measures with a plan at the beginning of the year will not only serve your patients well, it will help you to maximize your practice star ratings and performance in your value based care contracts.

Finally, the Extreme and Uncontrollable Circumstances (EUC), also known as Covid protection, was sunset from star ratings calculation. This protection likely increased the star ratings performance for health plans, and conversely for practices, in 2022, and will not be a factor in 2023.

Overall, the changes and updates shared by CMS are in alignment with past updates, and the end result will be that you as a practice stakeholder will need to approach the year with a plan. Begin working with your internal team, consultants, and health plans as early as possible to drive your best results - for your patients health, for your practice, and for the health plans.

The full extent of the changes, mostly impacting health plans, can be seen in the Medicare Star Ratings Fact Sheet.