The Centers for Medicare & Medicaid Services (CMS) publishes the Medicare Advantage (Medicare Part C) and Medicare Part D Star Ratings each year to measure the quality of health and drug services received by consumers enrolled in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans). The Star Ratings system helps Medicare consumers compare the quality of Medicare health and drug plans being offered so they are empowered to make the best health care decisions for them. An important component of this effort is to provide Medicare consumers and their caregivers with meaningful information about quality alongside information about benefits and costs to assist them in being informed and active health care consumers.
Changes in the Methodology for the 2023 Star Ratings
Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures; MA-only contracts (without prescription drug coverage, or Part D) are rated on up to 28 measures; and stand-alone Part D (PDP) contracts are rated on up to 12 measures. As finalized in previous rulemaking, the updated Controlling Blood Pressure (Part C) measure was re-specified and was transitioned off the display page and into the 2023 Star Ratings as a new measure. This measure has a weight of 1 for the first year (2023 Star Ratings) and a weight of 3 thereafter. Starting with the 2023 Star Ratings, the Rheumatoid Arthritis Management (Part C) measure was retired and the updated Statin Use in Persons with Diabetes (Part D) measure weighting category was implemented (changed from an intermediate outcome measure with a weight of 3 to a process measure with a weight of 1).
Guardrails were introduced in the 2023 Star Ratings for all measures that have been in the Part C and D Star Rating program for more than three years except the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and the Part C and Part D improvement measures. Guardrails are bi-directional caps that restrict upward and downward movement of a measure’s cut points for the current year’s measure-level Star Ratings compared to the prior year’s measure-threshold specific cut points. The weight of patient experience/complaints and access measures increased from 2 to 4 for the 2023 Star Ratings.
For the 2023 Star Ratings, the only adjustments for the impact of the COVID-19 public health emergency (PHE) are the measure-level adjustments for three Healthcare Effectiveness Data and Information Set (HEDIS) measures derived from the 2021 Health Outcomes Survey (HOS). The 2022 Star Ratings included measure-level adjustments for other (non-HOS) measures under the extreme and uncontrollable circumstances rules as a result of the COVID-19 PHE. For example, for most measures, if a measure-level Star Rating was lower for the 2022 Star Ratings relative to the prior year, the measure-level Star Rating (and numeric score) reverted to the rating (and numeric score) from the 2021 Star Ratings (see 42 C.F.R. §§ 422.166(i), 423.186(i)).
Measure Level Changes
Data from the 2019 through 2021 measurement periods help us understand how the PHE impacted the care delivery system. Tables 1-3 below include information at the national level about the overall change in contract-level average measure scores (i.e., unweighted by the size of the contract) from the 2021 to 2023 Star Ratings (for all measures without a substantive specification change across the three years). The scores are shown prior to any adjustments under the extreme and uncontrollable circumstances rules; thus, they reflect actual performance during the measurement period. The measures in Tables 1-3 are shown in order of which have the largest increases to the largest decreases in scores from the 2021 to 2022 Star Ratings. The arrows indicate whether the change in scores is positive or negative from the 2022 to 2023 Star Ratings. The last column of these tables highlights more substantive changes of 2 percentage points or more in either direction.
- Part C measures are displayed in Table 1 for MA contracts. Scores for most measures for the 2023 Star Ratings show a negligible change in both directions compared to data from the prior year at the national level. The Diabetes Care — Blood Sugar Controlled and Osteoporosis Management in Women Who Had a Fracture measures show larger increases. Two of the HEDIS measures collected through HOS (Improving Bladder Control and Reducing the Risk of Falling), the measure Call Center — Foreign Language Interpreter and TTY Availability, and the measure Members Choosing to Leave the Plan show larger declines.
- Part D measures are displayed in Tables 2 and 3 for MA-PD and PDP contracts, respectively. Most measure score changes between the 2022 and 2023 Star Ratings were small overall in both directions.