21-259m Medicare Star Ratings for 2021 and Beyond
Date: 03/31/21
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
Changes and resources to help you provide patients the highest quality of care and experience
Medicare uses a Star Ratings System to measure how well Medicare Advantage (MA) and Part D plans perform. Medicare scores how well plans perform in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest and one being the lowest.
In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) made some changes to the 2021 and 2022 Star Ratings. The changes ease data requirements to help data collection disruptions, reduce member interaction, and lessen provider office burden.
We support and work with providers in their efforts to focus on their patients and improve Star Ratings.
Member expectations
With CMS placing a heavier emphasis on member needs and experiences, it is important to understand members’ expectations in order to deliver optimal personalized care and support. Strategies to increase member engagement will have significant impact on health plans’ overall Star Ratings. Innovative tools and technology, expansion of telehealth services and utilization of virtual health platforms can help Medicare plans and providers improve quality measurement and reporting amid the COVID-19 pandemic.
Proposed new measure concepts
CMS solicited feedback on the two new measure concepts listed below, and continues to explore their utility and feasibility. If these measures are included in the CMS Star Ratings, they will be on the display page1 for at least two years prior to becoming a Star measure.
- Provider Directory Accuracy: A new measure that considers what percent of plan information is inaccurate.
- COVID-19 vaccination: Pending rule making, include a COVID-19 vaccination measure on the display page for 2024 as a potential Star Ratings measure.
Codified changes to the Star Ratings Program
The changes below to the Star Ratings Program were proposed October 30, 2020 in the 2022 MA and Part D Advance Notice Part II. They were codified in the 2022 MA and Part D Final Rule announcement on January 15, 2021.
| RY2021 | RY2022 | RY2023 | RY 2024 |
|---|---|---|---|---|
Healthcare Effectiveness Data and Information Set (HEDIS®) Data | 2020 data not collected (use measurement year (MY) 2018 data) | MY 2020 | MY 2021 | MY 2022 |
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Data2 | 2020 data not collected (use survey year 2019 data) | 2021 | 2022 | 2023 |
CAHPS measures |
|
| Increase weight to 4x |
It is important to note the quadruple-weight increase for the CAHPS measures in the Star Ratings, with greater emphasis on overall member experience. The increased weight from 2x to 4x began January 1, 2021 (impacting 2023 Star Ratings). Measures impacted include CAPHS, disenrollment, appeals, complaint tracking modules (CTMs), call center and complaints measures.
CMS also made the changes below to Star measure cut-point calculations:
- Removed Tukey outliers3 from cut points beginning MY 2022.
- Cut-point guardrails3 implementation delayed until the 2023 Star Ratings.
Star Ratings Measurement changes
Refer to the table below on changes to existing, display, retired and proposed measures for the upcoming years.
Changes | Description |
|---|---|
Changes to existing measures | Statin Use in Persons with Diabetes (SUPD) The percent of Medicare Part D beneficiaries ages 40 to 75 who were dispensed at least two diabetes medication fills and received a statin medication fill during the measurement period. The index prescription start date for the SUPD measure should occur at least 90 days prior to the end of the measurement year (MY). Beneficiaries are included in the SUPD measure calculation if the earliest date of service for a diabetes medication is at least 90 days prior to the end of the MY. The measure will be a weight of 1x for the 2023 Star Ratings. |
Display measures | Controlling Blood Pressure (CBP) Temporarily moved to the display page for the 2020 and 2021 Star Ratings due to substantive National Committee for Quality Assurance (NCQA) changes to the measure specification. Since HEDIS data was not collected for 2021 Star Ratings, this measure remains as a display measure for 2022, and will be used in calculating the 2023 Star Ratings with a weight of 1x. The measure will increase in weight to 3x for 2024 Star Ratings (MY 2022). |
Medicare Health Outcomes Survey (HOS) Measures: Improving or Maintaining Physical Health (IPH) and Improving or Maintaining Mental Health (IMH) Moved to the display page for at least two years beginning in MY 2022 due to substantive measure specification changes. Possible return to 2026 Star Ratings with a weight of 1x. | |
Care for Older Adults (COA) – Functional Status Assessment Moved to the display page for the 2022 Star Ratings due to a substantive measure specification changes. | |
Plan All-Cause Readmissions (PCR) Temporarily moved to the display page for the 2021 and 2022 Star Ratings due to substantive NCQA changes to the measure specification. It will be on the display page for the 2022 and 2023 Star Ratings, and return for MY 2022 with a weight of 1x for the 2024 Star Ratings. | |
Retired measures | Adult BMI Assessment (ABA) Retire with the 2022 Star Ratings. |
Rheumatoid Arthritis Management (ART) Retire with the 2023 Star Ratings. | |
Medication Reconciliation after Discharge (MRP) Retired as a standalone measure in MY 2022 for the 2024 Star Ratings. MRP will continue as a Star measure – as a sub-measure – under the new Transitions of Care measure (listed below). | |
Osteoporosis Testing in Older Women (OTO) Retire for MY 2020 and will be removed from the display page in 2023. | |
Proposed measures | Follow up After ED Visit for Persons with Multiple Chronic Conditions (FMC) Percentage of emergency department (ED) visits for members ages 18 and older who have multiple high-risk chronic conditions and had a follow-up service within seven days of the ED visit. Eligible members must have two or more of these chronic conditions: COPD and asthma; Alzheimer’s disease and related disorders; chronic kidney disease; depression; heart failure; acute myocardial infarction; atrial fibrillation; and stroke and transient ischemic attack. This will be a Star measure starting RY 2024 with a weight of 1x |
Transitions of Care (TRC) Percentage of discharges for members ages 18 and older who had each of the following: 1) notification of admission and post discharge: 2) receipt of discharge information, 3) patient engagement, and 4) medication reconciliation. This will be a Star measure starting RY2024 with a weight of 1x. | |
Cardiac Rehabilitation (CRE) The percentage of members ages 18 and older, who attended cardiac rehabilitation following a qualifying cardiac event, including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, heart and heart/lung transplantation or heart valve repair/replacement. | |
Kidney Health Evaluation for Patients with Diabetes (KED) The percentage of members ages 18 to 85 with diabetes (type 1 and type 2) who received a kidney health evaluation, defined by an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR), during the measurement year. | |
Osteoporosis Screening in Older Women (OSW) The percentage of members ages 65 to 75 who received osteoporosis screening. |
Non-substantive changes to Star Measures
There are several non-substantive changes to existing measures for 2022 Star Ratings that allow for additional data sources as part of the measure. Since these are non-substantive changes to the measures, CMS will not move them to the display page as they would for new measures and those with substantive specification changes. The majority of these measures are revised to include telehealth (telephone visit, e-visit, virtual check-in) as qualifying numerator/denominator events, and for advanced illness exclusions to ensure Medicare beneficiaries have access to necessary care during the pandemic.
Measure | Change Description |
|---|---|
Breast Cancer Screening (BCS) | Added telephone visit, e-visit and virtual check-in encounter codes to identify the advanced illness diagnosis exclusion. |
Care for Older Adults (COA) | Clarified that for the numerator, services rendered during a telephone visit, e-visit or virtual check-in meet criteria for Functional Status Assessment and Pain Assessment numerator indicators. |
Controlling High Blood Pressure (CBP) | Removed the restriction that only one of the two visits with a hypertension diagnosis could be an outpatient telehealth, telephone visit, e-visit or virtual check-in when identifying the event/diagnosis and added telephone visit, e-visit and virtual check-in encounter codes to identify the advanced illness diagnosis exclusion. This measure allows patient self-reported blood pressure readings using any digital device to be included in the data capture. |
Comprehensive Diabetes Care (CDC) | Removed from the denominator the restriction that only one of the two visits with a diabetes diagnosis could be an outpatient telehealth, telephone visit, e-visit or virtual check-in (when identifying the event/diagnosis) and added telephone visit, e-visit and virtual check-in encounter codes that could be used to identify the advanced illness diagnosis exclusion. |
Colorectal Cancer Screening (COL) | Added telephone visit, e-visit and virtual check-in encounter codes to identify the advanced illness diagnosis exclusion. |
Osteoporosis Management in Women Who Had a Fracture (OMW) | Added telephone visit, e-visit and virtual check-in encounter codes to identify the advanced illness diagnosis exclusion. |
Plan All-Cause Readmissions (PCR) | Added telephone visits to the Risk Adjustment Comorbidity Category Determination in the Guidelines for Risk Adjusted Utilization Measures. |
Statin Therapy for Patients with Cardiovascular Disease (SPC) | Removed the restriction from the denominator that only one of the two visits with an ischemic vascular disease (IVD) diagnosis could be an outpatient telehealth, telephone visit, e-visit or virtual check-in (when identifying the event/diagnosis) and added telephone visit, e-visit and virtual check-in encounter codes to identify the advanced illness diagnosis exclusion. |
Provider resources to help improve outcomes
In addition to adherence with CMS Star Ratings, Health Net collaborates with participating providers to improve the overall health care delivered to Health Net MA members through the following efforts:
- Quality Improvement initiatives – As part of Health Net’s Star Ratings initiatives, Health Net performs member outreach through mail, email and interactive voice response (IVR) calls to promote best practices in preventive screening, medication adherence and chronic care. Members are encouraged to complete annual wellness visits and talk to their doctor about fall risk, urinary incontinence and physical activity. Collaborating with providers to implement strategies promoting best practices can have a meaningful impact on Health Net’s Medicare Star Ratings. A provider quality improvement (QI) toolkit is available with information about QI activities and CMS Star Ratings, as well as provider and member resources. In addition, provider educational teleconferences on various health topics, including HEDIS best practices, are available to medical groups throughout the year.
- Quality Improvement Corner tools – Providers can log in to Health Net’s provider portal and select Working with Health Net > Quality to access QI tools created to improve Star Ratings in Part C and Part D clinical measures. By adhering to best practices to strengthen patient engagement and close gaps in care, providers can directly impact HEDIS, HOS and CAHPS quality measures. The QI tools located on this site include documentation guides; provider tip sheets to improve preventive care, chronic care and patient experience; wellness and preventive care checklists; and educational office posters. Hard copies can be requested via email.
- Collaborating with Health Net – To identify areas for improvement on specific HEDIS measures, Health Net provides medical groups with year-to-date HEDIS quality report cards and care gap reports available online.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email within 60 days, by telephone at 800-929-9224.
1 CMS publishes display measures each year, which include measures that have been transitioned from the Star Ratings, new measures that are tested before inclusion into the Star Ratings, or measures displayed for informational purposes only. These are separate and distinct from CMS’s Part C & D Star Ratings.
2 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys ask consumers and patients to report on and evaluate their experiences with health care.
3 For more information, refer to the CMS Medicare 2021 Part C & D Star Ratings Technical Notes.