Understanding 2023 Medicare Advantage Star scores

Understanding 2023 Medicare Advantage Star scores
Nov 29, 2022
4 MIN. READ
When individuals look to enroll in or change their Medicare Advantage (MA) plan, the Five-Star Quality Rating System (also referred to as Star scores or Star ratings) is one tool that can help determine which plan is best for them. The Centers for Medicare and Medicaid Services (CMS) publish Star scores yearly in the fall as a precursor to the Medicare open-enrollment period and aim to empower individuals in choosing the right plan by scoring them on a one to five scale—with five as the highest score attainable. Members can look at both the overall score and individual components to see if a plan meets their needs.

2023 sees a drop in Star scores

graph

graoh

*CMS data.

 

Released in October, the 2023 Star scores show a sharp decline from 2022 scores, with the average lowered by 0.22. This decline, though seemingly alarming, can be attributed to two main factors.

The first is the removal of 2022 guardrails that were put in place by CMS due to the COVID-19 public emergency. These guardrails prevented Star scores from lowering in 2022, permitting plans to revert to the rating from 2021 if their calculated 2022 score was going to be lower. This rule, created to counteract negative impacts on the ratings due to the pandemic, likely created a false inflation of ratings during 2022 that precipitated 2023’s sharp decline. Despite this reality, any lowering of a plan’s Star score can cause member concern and dissatisfaction which could, in turn, lead to an increase in voluntary attrition as members look for higher-rated plans.

The second factor in Star rating declines relates directly to patient care. For the 2023 ratings, the weight of patient experience and access measures doubled, increasing from two to four. In addition, all six Consumer Assessment of Healthcare Providers (CAHPS) measures are down on average, with the largest drops for the measures “Getting appointments and care quickly” and “Getting needed care,” which both saw an average decrease of about 1.8%. While that decline can likely be attributed to long-term impacts from COVID-19 and the accompanying backlogs for patient care, they do still show a significant decrease in member satisfaction. Given that, it is likely that plan scores in this area will weigh heavily into member decisions both now and in future years.

CAHPS measures are not the only indicator with a significant decrease in customer satisfaction. Voluntary member attrition, an important Star rating measure, saw an increase of approximately 2.5% compared to 2022—meaning that more members continue to elect to disenroll from their MA plans. This is particularly alarming for payers considering the impact it has on profit margins. With MA plans, it takes an average of four years for a member to become profitable. Thus, losing members before that time results in a net loss for payers. With overall satisfaction rates decreasing, we can expect this measure to grow next year. To combat that, it is essential that plans prioritize member satisfaction and minimize points of friction as much as possible.

Understanding the impact of lower Star scores on buyers

Members should not panic about the overall lowering of Stars scores. However, they should look critically at their plans to determine whether they should shop around this enrollment season. To make this decision, there are a few key factors within the Star score rating system that members should and will look to:

Benefits: These indicators can be more personal, depending on which specific healthcare needs and wants a member may have, but still follow a general trend across the board. Members will look to see if their plan:

  • Reduces benefits
  • Narrows providers or pharmacies
  • Stops pandemic-related flexible policies

Member experience: To narrow it down, members will look to whether the plan:

  • Maintains adequate customer service
  • Conducts appropriate, effective, and caring outreach
  • Consistently meets member expectations

Considerations and opportunities for payers amid changing scores

Payers should look at this year’s scores as an opportunity for improvement and growth. With only 21.87% of members enrolled in five-star plans, we can expect members to shop around more actively during open enrollment to pursue higher-scoring plans.

To achieve this growth, plans need to find substantial ways to improve upon their score. With this year’s scoring changes, CMS gives more weight to member satisfaction and experience, which is an area where quality has decreased and is currently low across the board. When looking to improve their scores, payers should plan to spend the 2023 year strengthening their member experience to improve their overall member satisfaction and ensure they stand out when the 2024 scores are released next fall.

Delivering measurable outcomes with customer experience transformation

When looking to improve member experience, it is critical that MA payers look for a partner with specific knowledge and skills in customer experience transformation (CXT) and a strong background in healthcare. Relying on a partner with extensive expertise in CXT that emphasizes targeted transformation, focused on meeting the needs of customers, can help payers better understand members and what they look for in their healthcare journey.

Creating a customizable journey with such a partner will improve upon MA plans and deliver measurable outcomes across an organization. Viewing the 2023 Star scores for what they are—not a static rating of plans, but a roadmap for improvement—will allow organizations to evolve their approach to provide the experiences members want and need while continuing to drive growth.

ICF’s global marketing services agency focuses on helping your organization find opportunity in disruption.
Go to ICF Next
Meet the authors
  1. Leah Sheveland, Partner, Healthcare

    Healthcare Leader with over 15 years of management experience. Specialized in leading cross-functional teams in the areas of payer operations, Medicare Advantage, retail health expansion, and strategy definition. View bio

  2. Aditi Mittal, Senior Business Consultant

The latest marketing trends, uncovered.

Subscribe to get insights, commentary, and news sent straight to your inbox.