Last week and just ahead of open enrollment, the Centers for Medicare & Medicaid Services (CMS) released its annual Star ratings for Medicare Advantage Part C and Part D plans.

While the COVD-19 pandemic certainly impacted the 2021 CMS Star Ratings—some carried-over 2020 data was one factor—weight shifts and a large number of “too new” plans were also part of the mix. 

Some of the most notable stats included:

  • A majority (77%) of Medicare Advantage enrollees will be in a four-star or higher plan in 2021—but that’s down from 81% last year.
  • Only 17% of enrollees will be in stand-alone drug plans rated four stars or higher.
  • 28 plans—one more than last year—were awarded the highest rating of five stars.

Each year’s Stars release also has implications for how plans will need to approach member engagement strategies in the days ahead. Of course, plans with disappointing scores will need to dissect the causes for lower-than-hoped-for individual measures and develop strategies to improve. In addition, there are several universal takeaways:

Competition continues to heat up, making stand-out member engagement essential

With 2021 Medicare Advantage premiums expected to be the lowest in 14 years,many plans adding new types of enticing benefits and 212 MA-PD contracts listed as “too new to be measured,” heightened competition is certainly on the radar.

Established plans can expect the newer plans to pursue out-of-the-gate higher scores with a focus on consumer-centric operations and member services. In their quest to become five-star rated plans, these newer players will be looking for ways to take health plan consumer engagement to the next level, build long-term trust with members, address any barriers to wellness and simplify access to both care and plan information.

Whether they’re an established plan or a new kid on the block, every plan will want to make engagement optimization a priority moving forward—including refining contact strategies, channels and approaches that limit outreach fatigue and abrasion.

Addressing medication adherence remains important

With at least one-third of Americans not taking their medications as prescribed, medication adherence has continued to impact Star ratings. This year, the average medication-related MA-PD measure score dropped, while the Statin Use in Persons with Diabetes (SUPD) measure—triple weighted for the first time—dropped .4 stars on average.

Plans looking to have a competitive Stars advantage will need to sharpen their focus on improving adherence levels well beyond simple refill reminders. Taking time to understand the reasons why a member isn’t taking their medication is a good first step. Plans should also consider strategies to:

  • Engage with people via live phone outreach (with multi-channel follow-up as needed) regarding their medication goals, needs and preferences. Our years of experience shows us how effective one-to-one personal connections can be for the Medicare population. (Read this interesting mini-case study here.)
  • Identify and assist with any social determinants of health that may be at play. (Get more ideas here.)
  • Proactively offer cost-saving solutions, like generic drugs and mail-order pharmacy options. (Here’s a quick-read case study on that topic.)

Align your engagement planning with key experience measures

Staying on top of evolving measures and ensuring you follow best practices for member engagement will remain necessary. Patient/member experience measures in particular must be a priority, as measure weights are increasing exponentially. As you plan your engagement programs for 2021 and beyond, here a few of the measures you’ll want to address early and often:

Part C Measures

2021 Average Star  Rating

Getting Needed Care (CAHPS)

3.3

Getting Appointments and Care Quickly (CAHPS)

3.4

Customer Service (CAHPS)

3.5

Rating of Healthcare Quality (CAHPS)

3.3

Rating of Health Plan (CAHPS)

3.2

Care Coordination (CAHPS)

3.4

Members Choosing to Leave the Plan

4

Plan Makes Timely Decision About Appeals

4.3

Call Center – Foreign Language Interpreter and TTY Availability

4.3

 

Part D Measures

2021 Average Star Rating

Call Center – Foreign Language Interpreter and TTY Availability

4.4

Complaints about the Drug Plan

4.8

Rating of Drug Plan (CAHPS)

3

Getting Needed Prescription Drugs (CAHPS)

3.5

 

>>> Tip: Use our Stars engagement toolkit with roadmap templates for easier planning.

 

How can we help? Turn to the Carenet Health experts for insights and best practices for Medicare member engagement—including closing gaps in care. We’re here to brainstorm ideas and help you benchmark and improve existing efforts, too. Contact us today. For comprehensive Stars consulting, we recommend Stars expert Rex Wallace.