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Medicare Star Announcement Shows Continued High Performance Overall, But Churn Among Plans

Medicare Star Announcement Shows Continued High Performance Overall, But Churn Among Plans

As we have seen over the past few years, the 2019 Star announcement shows that the Centers for Medicare and Medicaid Services (CMS) effort to improve quality in the Medicare Advantage program continues to pay huge dividends. But while quality is being maintained at unprecedented levels, many plans continue to struggle to achieve and maintain high ratings.

To tout CMS’ and plans’ achievements in Star, as we always do we compare the progress the program has made back to 2010 when the Affordable Care Act revamped the Star performance program. In 2010, just 14 percent of Medicare Advantage-Part D (MA-PD) plans achieved a 4 Star or greater rating and only 25 percent of members were in such plans. For 2019, CMS anticipates that 45 percent of all plans will have 4 Star or greater ratings and almost 74 percent of members will be in such plans. While the number of plans reaching 4 Star status was about 50 percent in 2017, the 74 percent number is a record for the program. The results continue to show that Grandma and Grandpa are savvy, reading up and gravitating to high-performing plans.

At the same time, aggregate results are holding steady, with many plans still struggling in the performance system.

  • The average MA-PD score dropped from 4.07 in 2018 to 4.05 in 2019.
  • Again, well less than 50 percent of all rated contracts were able to achieve 4 Star status.
  • While 16 plans hit 5 Star in 2018, just 14 did so for 2019. What’s more, nine of the sixteen 5 Star plans from 2018 lost their coveted rating for 2019. A few plans that lost their top rating in the past have gained it back, including Humana’s CarePlus Health Plan in Florida as well as Cigna-HealthSpring of Florida. Humana added another top tier plan, as well. Kaiser still has 4 plans in the top tier. Tufts and Gundersen also continue to maintain their status as top tier plans.
  • About the same number of MA-PD plans – 171 in 2018 and 170 in 2019 – earned 4 Star or greater ratings. But churn is still evident across the board. We will publish our analysis of those plans that gained Star Power and those that Lost Star Power, but our preliminary numbers show that about 50 percent remained the same as last year. Of the remaining 50 percent, about half of this group gained and half lost Star Power. Slightly more plans lost Star Power than gained it.
  • There are slightly more 4.5 Star plans and slightly fewer 4 Star plans. There are fewer 3.5 Star plans and more 3 Star plans.
  • Standalone Part D plans took a tumble. In 2018, 28 contracts earned 4 Star and above; in 2019, that is only 16. Over 47 percent of PDP enrollees were in 4 Star or above in 2018 (mostly in 4 Star plans). In 2019 that will be just 3 percent. While most members were in 3.5 and 4 Star plans in 2018, now most will be in 3 and 3.5 Star plans.
  • As we have seen in the past, tenure in the program appears to be one of the best indicators of Star performance.
  • The churn seen in plan performance was also visible in average ratings for measures:
    • MA-PD Part C – 14 improved, 15 went down, and five remained the same or were new for 2019 rating.
    • MA-PD Part D – four improved, six decreased, and three remained the same or were new for 2019 rating.
    • Standalone Part D plans – three improved, eight decreased, and three remained the same or were new for 2019 rating.

See additional Star performance data here.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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