Looking for information on hospital star ratings? Please see last year’s blog.
What are Star Ratings?
Last year we discussed CMS hospital star ratings. These ratings help patients understand how well hospitals perform across a number of quality measures. This helps patients make informed decisions about where to go for hospital services.
The Medicare Advantage and Medicare Part D star ratings are similar in that they are meant to help patients compare and contrast plans. Medicare Advantage plans are evaluated on about 30-40 different quality and performance measures, depending on whether they provide prescription drug coverage or not.
CMS states that the performance measures fall into several categories:
- Outcomes: Measurements of actual improvements to plan members’ health
- Intermediate outcomes: Measurements of actions that could lead to improvements in plan members’ health
- Patient experience: Measurements of how plan members perceive their care
- Access: Measurements of the obstacles that keep plan members from getting care and the solutions to those obstacles
- Process: Measurements of services that can help plan members monitor, maintain, or improve their health
Many of the measures within these categories deal with helping people with chronic conditions. Since chronically-ill patients tend to utilize healthcare services at a higher rate, take more medications, and struggle with access, their health and well-being are a good measure of a plan’s ability to perform.
How Delivery Can Help
There are many things that Medicare Advantage plans can do to improve their star ratings. But here’s an option that has been seriously underused: home prescription delivery.
It’s obvious that home delivery can increase a patient’s PDC and improve medication adherence for patients with diabetes, hypertension, or high cholesterol. But delivery can also boost a plan’s ratings in how they manage chronic conditions or anticipate and meet patients’ needs.
Part C measures
| Domain | Measure |
|---|---|
| 2: Managing Chronic (Long Term) Conditions | C05 - Special Needs Plan (SNP) Care Management |
| C08 - Osteoporosis Management in Women who had a Fracture | |
| C10 - Diabetes Care - Kidney Disease Monitoring | |
| C11 - Diabetes Care - Blood Sugar Controlled | |
| C12 - Rheumatoid Arthritis Management | |
| C14 - Improving Bladder Control | |
| C16 - Statin Therapy for Patients with Cardiovascular Disease | |
| 3: Member Experience with Health Plan | C20 - Rating of Health Care Quality |
| C21 - Rating of Health Plan | |
| 4: Member Complaints and Changes in the Health Plan’s Performance | C23 - Complaints about the Health Plan |
| C24 - Members Choosing to Leave the Plan |
Part D measures
| Domain | Measure |
|---|---|
| 2: Member Complaints and Changes in the Drug Plan’s Performance | D02 - Complaints about the Drug Plan |
| D03 - Members Choosing to Leave the Plan | |
| 3: Member Experience with the Drug Plan | D05 - Rating of Drug Plan |
| D06 - Getting Needed Prescription Drugs | |
| 4: Drug Safety and Accuracy of Drug Pricing | D08 - Medication Adherence for Diabetes Medications |
| D09 - Medication Adherence for Hypertension (RAS antagonists) | |
| D10 - Medication Adherence for Cholesterol (Statins) | |
| D12 - Statin Use in Persons with Diabetes (SUPD) |
Be Proactive
The Medicare Advantage market is more competitive than ever. Even plans who already score highly across the board need to consider how they can keep their scores high, especially as patient experience measures are expected to increase in weight for 2023. Plan administrators, don’t wait until your ratings drop – look for ways to retain your members and keep their healthcare experience consistently positive.
Obviously, we suggest offering members home delivery of their prescriptions. By ensuring Medicare Advantage patients receive their medications promptly and stay on therapy, you can secure high ratings in a wealth of measures across multiple domains.
Plus, after enrolling in a plan, most members use their prescription benefits first. With ScriptDrop delivery, plans can make a great first impression and establish a strong relationship with members as soon as they enroll.
Curious how ScriptDrop can benefit your CMS star ratings? Learn more on our site or reach out directly at sales@scriptdrop.co.