CMS’s Stars Trade-off Concept: More Visibility in Return for More Responsibility

By James Gutman - December 7, 2012

There is one message that seems particularly clear in the second annual installment of CMS’s memo previewing upcoming changes in the Medicare Advantage and Part D star ratings. The agency now is willing to give MA plans visibility into what changes it is considering not only for the next year’s star ratings but also for the year after that and beyond, and even to say what plans will need to attain to get a four-star rating in some of the measures for 2015. This change draws praise from MA consultants, who point out it’s the first time CMS has given two years of notice on such key information. But the upcoming new measures also demonstrate that CMS increasingly intends to hold plans accountable not only for their own performance but for that of their provider networks as well.

Consider, for instance, one of the measures CMS discusses in its Nov. 30 memo about contemplated “enhancements” to the star ratings. The agency says it may add to the 2014 display page in preparation for potential inclusion in the 2015 star ratings Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures about contact with the plan member from a doctor’s office and pharmacy, as well as the plans’ efforts on such aspects as reminders to get tests or vaccinations, follow-up after hospital stays, and ensuring that prescriptions get filled or refilled and medications are taken. Another potential new measure in the same time frame is use of highly rated hospitals, something that also will put a premium on plan relationships with providers.

MA plans in the past, notes consultant Nathan Goldstein, CEO of Gorman Health Group, LLC, were geared up just to contract with providers in their service areas. Now, he says, they will need to get more deeply involved, and they may even need to reassess those service areas if only low-performing hospitals are located there.

What do you think of these changes and trends in this installment of CMS’s preview of coming star-rating measures? Is the agency pushing plans in the right directions? Can the plans get there? Is having the additional advance notice going to enable plans to see stars more clearly or just in their nightmares?

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