The Impact of Proposed Changes to the CMS Star Ratings Program

March 16, 2023 | Carenet Health

Last year, the Centers for Medicare and Medicaid Services' (CMS) proposed adding a health equity index to its Star Ratings program that would reduce the weight of the measure related to patient experience and negative feedback. Although updates made by CMS in past years were meant to better account for the member experience, the revised analytics driven by the proposed changes have the potential to affect patient adherence to treatment plans and could adversely impact health outcomes.

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The potential change was announced in December 2022 in a published document entitled Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program. With this, CMS is proposing to reduce the weight of patient experience/complaints for its Star Ratings in 2026. CMS stated that after "taking into consideration additional stakeholder feedback… we believe these measures currently receive an undue weight in the Star Ratings program."

The proposed ruling also stated that the changes "will focus provider attention, reduce provider burden… and allow for cross-comparisons across quality and value-based care programs, to better understand what drives quality and equity improvement and what does not." 

There is already enough evidence to determine a weight of 1.5 for the Patient Experience/Complaints and Access measure has a negative impact on patients. It disincentivizes health plans from investing in measures designed to improve the patient experience and take meaningful steps to respond to their direct feedback.

In this sense, lowering the weight from 4 back to 2 seems like a step in the wrong direction. Some thought leaders argue that with this move, CMS is decreasing the likelihood that plans will take action against the real-life challenges that patients face when accessing and benefiting from care. It also reduces financial compensation for those who do take steps to improve a patient's healthcare experience, despite the fact that these actions have been shown to improve outcomes and reduce overall cost.

Looking Back at Previous Changes to the Star Ratings

When the Star Ratings program first introduced weights to its measures in 2012, Patient Experience and Access had a weight of 1.5, compared to a weight of 3 for Clinical Outcomes and 1 for Processes.

At the time, Patient Experience and Access (now termed Patient Experience/Complaints and Access) was one of the most neglected measures. Because it only affected around 30% of the total Star ratings, it was considered too difficult for plans to raise their score via improvements to factors that affected member experience, such as care coordination and access.

Recognizing this issue, CMS made a change in 2018 that brought the weight of patient experience measures from 1.5 up to 2. Now the patient's experience of care accounted for closer to 40% of the total Star Ratings, "given the importance of hearing the perspectives and voice of patients in times of need," according to CMS. Many health plans perceived that the weight of this measure might have been on track to increase even further.

With a greater Star Ratings emphasis on patient satisfaction, health plans began to focus on improvements to the patient experience like never before. New departments dedicated to this area were set up, new tools and analytics were identified and leveraged, and a variety of actionable steps were taken towards improving the aspects of care that matter to patients.

The change in the overall healthcare landscape was so impactful that in 2020 CMS decided the weight of Patient Experience/Complaints and Access would be doubled, from 2 to 4, making it virtually impossible for any plans to avoid addressing patient experience issues within their organization.

This change would be negated by the recently proposed ruling, which suggests the weight be dropped back down to 2.

Carenet Reaffirms its Commitment to Fostering Health Equity and Quality Care for All

Given these potential setbacks to the quality of the Medicare system, Carenet Health has reaffirmed its commitment to delivering advancements in healthcare consumer engagement that achieve the highest standard of care. Responding to the needs of healthcare consumers and supporting them in their patient journey is critical to fostering a more equitable health system in which quality care is available for all.
As the industry leader in healthcare consumer engagement, Carenet is a pioneer of programs and platforms designed to increase access to care, and bolster patient and member support.

Carenet provides a wide range of resources for Medicare Advantage plans focused on improving or maintaining CMS Star program ratings. Visit our Medicare Advantage content hub to browse briefs, e-books, case studies, infographics and more.

Click here to explore Carenet's Medicare Advantage content hub.

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