Are spooky STAR ratings haunting your Halloween? You’re not alone. Medicare Advantage (MA) STAR ratings continued to decline in the latest announcement from CMS on October 10th. The results, while not surprising, revealed a sobering reality: only 4 in 10 MA plans will earn the coveted four-star rating or higher in 2025. Coupled with recent headlines about major payers suing CMS, MA plan leaders may feel like STARs are heading towards a Zombie apocalypse, rather than showing signs of stabilization.
But the lawsuits are more about the ghosts of STAR ratings past rather than the current and future state of STAR ratings. Regardless of the outcome of those lawsuits, they will have little bearing on future STAR ratings as the metrics that matter most are changing.
The perfect potion starts with medication adherence
Starting this measurement year, member experience measures like the “secret shopper” calls that are the focus of the lawsuits, will drop from a 4X to 2X weight. However, as the patient experience weights decrease, medication adherence measures (diabetes, hypertension, and cholesterol) will maintain their weight of 3.0. and their relative contribution to overall scores increases.
When medication adherence begins to drive a higher percentage of the raw STAR scores, poor performance on medication adherence measures will have an even more dire impact on overall ratings – and affect quality bonus payments and rebates. On the less spooky side, strong performance is possible with the right approach and their right partners – and that performance could help to elevate STAR Ratings with the revised weight assignments.
Casting a magic spell for STAR ratings success
These pending measurement changes are both a challenge and an opportunity for MA plans. Haunted plans need a new path, especially the many that have long struggled to master medication adherence. MA plans need to rethink their Stars strategies to prioritize medication adherence if they want to maintain or improve their ratings.
To improve performance on medication adherence measures, MA plans must reevaluate their current practices. Unlike other measures that can “check the box,” and can be “one-and-done,” adherence measures are more complex. They require continual monitoring of members who qualify so that their prescription refills are properly timed.
Health plans must stop relying on the same old skeleton crew. Instead, it’s time to leverage tech-enabled services that use automated, data-driven processes to increase the probability of member engagement. It’s time to target high-risk beneficiaries with precision. By reducing the need for manual, labor intensive activities pharmacists and medication care coordinators can engage with more members, more effectively, in concert with their overall care.
To learn more about starting 2025 with a better STARS strategy that ensures high-performing medication adherence, please visit https://www.actualmeds.com/solutions#adherence-stars.