On October 10, CMS released its 2019 Star Ratings for Medicare Advantage (MA-PD) and Medicare Part D plans (PDPs). For 2019, ratings and enrollment distribution across MA-PD contracts remained relatively stable overall. However, that relative stability in average star ratings and the proportion of the population enrolled in 4+ star contracts (73%) belies underlying shifts as plans gain and lose 4- and 5-star status.

Notably, a number of companies showed progress across their portfolios in gaining 4+ star status. Further, the novel attainment of 5 stars by 8 contracts, including 3 from larger non-provider-based organizations, highlights plans’ ability to strive for and achieve high performance. While many contracts had changes to their star rating, projected enrollment in 4+ star MA-PD plans stayed at 73%, indicating that most beneficiaries will have the opportunity to remain in high-quality plans.

For PDP contracts, the decrease in the number of contracts with 4+ stars would result in a significant shift in distribution of enrollment in high-quality plans. If enrollees do not change their plans, the vast majority of 2019 PDP beneficiaries will be enrolled in plans with fewer than 4 stars. Some of the shifts in the PDP landscape are likely a result of updates to measures or changes to rating methodologies. These plans will need to examine how these changes may have impacted their individual ratings and identify opportunities to improve.

Insights from this year’s star ratings report include:

• Fewer contracts achieve 5-star status. For 2019, 19 contracts were given 5-star ratings: 14 MA-PD contracts, 1 MA-only contract, and 4 PDP contracts. In comparison, 23 contracts had 5-star ratings in 2018
• Nearly half of high-performing contracts are new to 5-star status. Among the 2019 5-star contracts, 9 were newly added: 7 MA-PDs (Careplus Health Plans, Health Options, Cariten Health Plan, Care Wisconsin Health Plan, Healthspring of Florida, Martin’s Point Generations Advantage, Gundersen Health Plan of Minnesota), 1 MA-only plan (Medical Associates Health Plan), and 1 PDP (Independent Health Benefits Corporation)
• 2019 enrollment in MA-PD contracts with 4+ stars is projected to remain constant. In 2019, the percentage of contracts earning 4+ stars slightly increased (from 44% to 45%). Using available 2018 enrollment to project for 2019, 4+ star plans will enroll 73% of the MA population, which is the same as 2018.
• Plan performance across measures is relatively consistent. Average Star Ratings on Part C measures fluctuated minimally, with no score exceeding a 0.5-star difference from 2018. The enrollment-weighted average star rating for all MA-PD plans decreased slightly from 4.07 in 2018 to 4.05. PDP performance on Part D measures generally declined; among the 13 measures with ratings from 2018, 8 experienced decreases in star ratings while only 3 experienced increases with none exceeding a 0.6-star change. The average overall Star Rating for PDP contracts in 2019, weighted by enrollment, was 3.29, down from 3.62 in 2018.
• Shifts in cut points impact ratings for some measures. Star ratings scores are calculated based on cut points, which are the thresholds that determine the “cut-off” score for each star rating. As in past years, cut points for many measures increased, raising the threshold for achieving higher star ratings. For example, all the 2019 cut points for the Part C Medication Reconciliation Post Discharge measure increased, with the 4-star cut point increasing from 55 to 66. Correspondingly, star rating performance on that measure across MA-PD plans decreased from 3.4 to 2.9.
• Enrollment in PDPs with 4+ stars is reduced. The number of PDP contracts with 4+ stars decreased from 28 in 2018 to 16 in 2019. If enrollees remain in these plans, this reduction would result in 3% of beneficiaries enrolled in these plans, compared to 47% in 2018. Further, enrollment in PDPs with 3 and 3.5 stars would increase from 44% in 2018 to 90% in 2019.

Our Take

Expected changes to plan requirements and to the star ratings methodology will continue to impact ratings and trends in future years. For example, CMS will begin to enrollment weight the measure scores of star ratings in contract consolidations for 2020. Additionally, MA-PDs that implement new supplemental benefit flexibilities may experience a positive impact on star ratings in the form of consumer satisfaction. Likewise, those MA-PDs utilizing other benefit flexibility (e.g., imposing step therapy for Part B medications) may see negative changes to their consumer satisfaction star ratings. For 2020, all plans should consider their strategic objectives and operational capabilities to maintain consistently high quality and achieve 4+ star ratings.

Learn More at Our Upcoming Webinar

For additional analysis and details on CMS’ 2019 Star Ratings release and a look at what’s to come for 2020 and beyond, we invite you to register for our upcoming webinar—It’s in the Stars: 2019 CMS Star Ratings—taking place November 1, 2018, at 1 PM ET. Gain the actionable insights and strategies you need to support future operational and performance improvement initiatives. Register for this free webinar today.

To learn more about Avalere’s policy work, connect with us.