Medicare Advantage Star Ratings: How do you measure up?

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.