CMS MA Star Ratings Work Group Discussion Forum

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1 CMS MA Star Ratings Work Group Discussion Forum 2016 First Plan Preview Period August 11, 2015

2 2016 CMS Star Ratings Updates 2

3 Methodology Changes to the Overall Star Rating For a few years CMS has expressed concerns about the misclassification of true performance. They are removing the pre-determined thresholds for the 2016 star ratings Provided contract-specific information based on this year s data through HPMS 83% of contracts had no change, 7% went up 0.5 stars and 10% went down 0.5 stars ACHP has updated its Gap Analysis to reflect the simulated thresholds and also created measure distribution charts 3

4 Improving or Maintaining Physical Health Star Rating Red line indicates a predetermined threshold. 4

5 Improving or Maintaining Physical Health Star Rating

6 Improving or Maintaining Mental Health Star Rating Red line indicates a predetermined threshold. 6

7 Improving or Maintaining Mental Health Star Rating

8 2016 Measure Inclusion Changes New measures Part D MTM Program Completion Rate Process, 1X Returning measures Part C Breast Cancer Screening Process, 1X Part C & D Call Center Foreign Language and TTY Availability (2 measures) Experience, 1.5X Part C & D Beneficiary Access Problems Access, 1X (increasing to 1.5X in 2017) 8

9 2016 Measure Inclusion Changes (cont.) Retired Measures Part C Cardiovascular Care Cholesterol Screening Part C Diabetes Care Cholesterol Screening Part C Diabetes Care Cholesterol Controlled Part D Diabetes Treatment Temporarily Moved to Display Page Part C Improving Bladder Control 9

10 Measure Specification Changes Part C Controlling Blood Pressure Timely Appeals Decisions All-Cause Readmissions Osteoporosis Management Part D Appeals Auto-forward and Upheld Medication Adherence Obsolete NCDs Part C & D Complaints about the Plan Quality Improvement CAHPS 10

11 CAHPS Measure Star Rating Assignment Changes Prior to 2015, low reliability scores could not receive 1 or 5 stars. Starting in 2015, Scores significantly below average and more than 1 SE below the 15th percentile receive 1 star. Scores significantly above average and more than 1 SE above the 80th percentile receive 5 stars. In these instances, there is strong evidence that the score is in the 1 star or 5 star range. *Non-reportable and very-low reliability scores do not affect the Star Ratings. 11

12 Other Updates & Notes Low enrollment contracts: Contracts with 500 or more enrollees as of July 2014 will be included. Data integrity: Propose to expand the use of data validation results as a new method of reviewing operational systems and verifying the validity of the data. Ex: Contracts who fail IRE data validation would be reduced on the appeals measures. Dual/LIS status: Will not move forward with interim step of reducing weights for seven measures but is continuing to look at the issue. 12

13 2017 and Beyond Potential changes to existing measures Medication Reconciliation Post Discharge: Possible inclusion on the 2017 Display Page and 2018 Star Ratings depending on HEDIS changes. CAHPS: Update from version 4.0 to 5.0 MPF Price Accuracy: CMS methodology changes to make a comprehensive assessment of price reporting. 13

14 2017 and Beyond (cont.) Potential new measures Care Coordination Asthma measure suite Depression Hospitalization for potentially preventable complications Statin Therapy High Risk Medication Opioid Overutilization Measurement concepts Alternative levels of evaluation Additional measures Sensitivity to small measure denominator size MA vs. MA-PD cut-points 14

15 2017 CMS MA Star Ratings Health Plan Activities Timeline Different measures are collected at different points in time. Plan your improvement efforts accordingly 2017 Star Ratings (2018 payment) HEDIS Care Delivered HEDIS Admin and Chart Review HOS Survey Survey Administered CAHPS CMS & Other Sources TODAY Drug Treatment Flu/Pneum Vaccines Survey Administered CTM/Call Center IRE and Audit Tracking Jan 2015 April 2015 August 2015 Jan 2016 Feb 2016 June 2016 Dec 2016 * For all dates, see Technical Notes for Parts C and D 15

16 2015 Star Ratings Timeline 1 st Plan Preview Period: August 7-18 Includes data but no star assignments No score for Quality Improvement measures 2 nd Plan Preview Period: Early September Includes data and star ratings for measures, domains, and overall levels Star Ratings anticipated to go live on October 8,

17 ACHP Preliminary Data Collection & Benchmarking ACHP will be collecting the first plan preview data from plans to compile into a blinded analysis. If you wish to be included in this analysis, please send your data (an excel file listing the measures and scores) to Chloe Stier at by August 14, We will send the compiled results to those who participated during the following week. 17

18 Discussion Do you see any potential issues in the data? Are there any (unexpected) significant changes in scores from last year? Have the measure specification changes caused any significant changes? Do you plan to raise any issues with CMS? 18

19 Upcoming ACHP Quality Timeline 2015 HPPG Release Commercial: August 19 at 1 pm EDT Medicare, SNP and Medicaid: early November NCQA Ratings: analysis available in late August; webinar in mid-september CMS MA Star Ratings: analysis available in late October; webinar in early November We are now scheduling custom presentations and adding analysis requests to the queue. 19

20 Topics of Interest for Future Work Group Meetings New and changing measures Medication Reconciliation Post Discharge: Possible inclusion on the 2017 Display Page CAHPS: Update from version 4.0 to 5.0 MPF Price Accuracy: CMS methodology changes to make a comprehensive assessment of price reporting. MTM programs in relations to star ratings performance Engagement with pharmacies 20

21 ACHP Resources HealthPlan Performance Gauge NCQA ratings performance Benchmarking packets Number Needed to Treat (NNT) tool CMS MA Star Ratings Gap Analysis & NNT tool Utilization benchmarking packets Connect to other ACHP member organizations Custom analyses and presentations 21

22 Contact Us Adam Zavadil Director, Market Strategy and Analysis Stephen Cox Manager, Business Improvement Programs Chloe Stier Business Analyst 22

23 1825 Eye Street, NW Suite 401 Washington, DC Phone: Fax:

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