Late last year CMS published a Part C and D STAR measure fact sheet (https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/Downloads/2020-Star-Ratings-Fact-Sheet-.pdf). In this month’s blog I present a few highlights that are especially pertinent to folks directing medication management and medication related quality improvement efforts.
In 2020, MA-PD plans will be evaluated on 45 quality measures (33 measures for MA only plans and 14 measures for PDP only plans). CMS conducts an extensive review of the measure set to be used each year, and has determined that there will be no changes in the STAR measures from 2019. CMS did however expand the adjusted measure set that is subject to the Categorical Adjustment Index (CAI). The CAI is the STAR measure performance adjustment (boost) that a plan receives when its members have a greater number of members who are dual eligible, disabled or qualify for a low income subsidy.
Most of the plans that CSS Health has partnered with are shooting for STAR rating status in, at least, the 4 STAR range. This is interesting as only approximately 52% (210) of the contracts offered in 2020 achieved a 4 STAR or higher rating. On the bright side, 81% of MA-PD enrollees are in a contract that achieved a 4 STAR rating.
CSS Health Take-Away: Enrollees tend to gravitate to high performing plans. Consequently, there are meaningful benefits to being rated as a high performing plan.
Five STAR status remains difficult to achieve with only 23 MA-PD contracts qualifying. There are plans whose STAR improvement efforts bore fruit with 9 new contracts achieving 5 STAR status. Encouragingly, CMS identifies relatively few contracts (only 5) that are classify as consistently low performers. In general, CMS found that there is a correlation with the number of years a plan has participated in the program and its overall STAR rating. Also, CMS finds only modest correlation between geography and STAR performance.
CSS Health Take-Away: STAR levels are not based on unmodifiable conditions such as geography. Quality measures can be materially improved using focused and novel techniques.
Probably the most interesting portion of the fact sheet is the change of a STAR measures over time. I have highlighted 11 drug related STAR measures that CSS Health recommends for inclusion in every Medicare Part D MTM program. These measures can all be improved as a part of a medication management program.
|C13||Diabetes Care – Eye Exam||3.4||3.6||3.8||3.8||11.7%|
|C14||Diabetes Care – Kidney Disease Monitoring||3.6||3.7||4.2||4.1||13.8%|
|C15||Diabetes Care – Blood Sugar Control||3.7||4.2||3.8||4.2||13.5%|
|C16||Rheumatoid Arthritis Management||3.9||3.4||3.0||3.6||-7.6%|
|C19||Medication Reconciliation Post Discharge||–||3.4||3.0||3.0||-11.7%|
|C21||Statin Therapy for Patients with Cardiovascular Disease||–||–||3.3||3.1||-6%|
|D10||Medication Adherence – Diabetes||3.5||3.3||3.7||3.9||11.4%|
|D11||Medication Adherence – RAS||4.0||3.7||3.1||3.3||-17.5%|
|D12||Medication Adherence – Cholesterol||3.5||3.3||3.2||3.4||-2.8%|
|D14||Statin Use in Persons with Diabetes||–||–||3.3||3.5||6%|
It is interesting to note that performance of almost half the drug related STAR measures have decreased over time. The measure that has had the most improvement (on a percentage basis) is the CMR Completion rate.
CSS Health Takeaway – Medication management programs should be configured to address STAR measure improvement synergistically. For example, the majority of CSS’s plans who achieve 5 STAR CMR rates, have integrated their MTM and post-discharge transitions efforts.
CSS finds meaningful “nuggets” of insight in these types of reports that assist us in continuously updating and improving medication management and drug related quality improvement programs. I am happy to discuss any aspect of medication management and approaches to better patient engagement and quality measure improvement.
Best – Jim
James Notaro, RPh, PhD
Founder and Chief Clinical Officer