Health Reform WK-EDGE The ratings are in—for Medicare Part C and D plans
Tuesday, October 20, 2020

The ratings are in—for Medicare Part C and D plans

By Cathleen Calhoun, J.D.

CMS gives ratings by stars, just like the movie critics, and 2021’s are available now.

A rating system is released each year with the purpose of measuring the quality of health and drug services received by beneficiaries enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans), according to CMS. CMS has released its latest ratings, "2021 Medicare Part C & D Star Ratings," and the year 2021 is given because ratings have been posted prior to the 2021 open enrollment period. Specific criteria were used in to measure the plans.

Rating system. In the rating system, plans are given stars, with 1 as the lowest, and 5 as the highest rating. CMS assigns half stars to the summary and overall ratings because, according to CMS, that allows for more variation across contracts. To be included in the Part C & D Star Ratings, a health or drug plan must have an active contract with CMS to provide health or drug services to Medicare beneficiaries. The only data used to rate the plans is data collected through normal contractual requirements or directly from CMS systems. Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 44 unique quality and performance measures. MA-only contracts (without prescription drug coverage) are rated on up to 32 measures. Stand-alone PDP contracts are rated on up to 14 measures. No new measures were introduced for 2021, but CMS increased the weight of patient experience/complaints and access measures from 1.5 to 2.

COVID-19. The COVID-19 Interim Final rule (85 FR 20628), effective March 31, 2020, adopted changes to the 2021 Star Ratings to accommodate the disruption in data collection due to the public health emergency (PHE) and made changes to the 2022 Star Ratings to account for expected changes in plan performance. CMS dropped the requirement to send Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data for the 2021 Star Ratings. Instead, CMS used the data from the prior year for the 2021 Star Ratings calculations, including carrying forward the measure-level change scores for HEDIS and CAHPS for the improvement measures. All other measures were updated using the most recent data.

Findings. Less than half of MA-PDs (194 contracts) that will be offered in 2021 earned 4 stars or higher for their 2021 overall rating. However, weighted by enrollment, about 77% of MA-PD enrollees are currently in contracts that have 4 or more stars for 2021. Only 28 total contracts received a high performing indicator, meaning that they earned 5 stars. Of those, 21 are MA-PD contracts, two are 1876 Cost contracts, and five are PDPs. The 28 total is an increase from 23 5-star contracts for the 2020 Star Ratings.

CMS has listed the high performers by name. A map of the United States is also provided, showing regions with higher and lower performance ratings.

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