News: CMS updates Medicare Advantage Star Rating calculations

CMS has changed its Star Rating system, placing greater weight on measures related to patient experience, reported HealthLeaders Media.

While previous studies have found consumers are dissatisfied with information and communication related to their plans and that only a small percentage of health plans reach out to consumers related to public health concerns, the primary changes to the Star Rating system are tied to patient access, experience, and complaints.

Star Ratings not only help consumers decide which plans to select, but also impact the plan’s eligibility to receive quality bonus payments, HealthLeaders Media reported. In the five-star system, plans much achieve at least four start to qualify for those payments.

There are 47 measures divided into categories that comprise the Star Rating score. Each category is assigned a weight of one to five. The patient experience, access, and complaints category was recently elevated from a weight of one-and-a-half to two. The category will be weighted a four in the 2023 ratings.

The 2023 effective date is deceptive though. The surveys related to those ratings will be conducted in 2022 and ask consumers to look back six months. Therefore, consumers' perceptions of their Medicare Advantage plans in the latter part of 2021 will be reflected in the 2023 Star Ratings.

Editor’s note: This article originally appeared in HealthLeaders Media. To read more about CMS Star Ratings, click here.