2017 Star Ratings

One of the Centers for Medicare & Medicaid Services’ (CMS) most important strategic goals is to improve the quality of care and general health status for Medicare beneficiaries. CMS publishes the Part C and D Star Ratings each year to: measure quality in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans), assist beneficiaries in finding the best plan for them, and determine MA Quality Bonus Payments. Moreover, the ratings support the efforts of CMS to improve the level of accountability for the care provided by physicians, hospitals, and other providers. Star Ratings are driving improvements in Medicare quality. The information included in this Fact Sheet is evidence of such improvement and is based on the 2017 Star Ratings published on Medicare Plan Finder (MPF) on October 12, 2016. 

Background

Medicare Advantage with prescription drug coverage (MA-PD) contracts are rated on up to 44 unique quality and performance measures; MA-only contracts (without prescription drug coverage) are rated on up to 32 measures; and stand-alone PDP contracts are rated on up to 15 measures. Each year, CMS conducts a comprehensive review of the measures that make up the Star Ratings, considering the reliability of the measures, clinical recommendations, feedback received from stakeholders, and data issues. All measures transitioned from the Star Ratings are included in the display measures available on this page http://go.cms.gov/partcanddstarratings. Changes to existing measures are summarized in Attachment A of this document. The 2017 Star Ratings also include an adjustment to account for the socioeconomic status of enrollees. This adjustment is described in Attachment B.

The Star Ratings measures span five broad categories:

• Outcomes
• Intermediate Outcomes
• Patient Experience
• Access
• Process

For the 2017 Star Ratings, outcomes and intermediate outcomes continue to be weighted three times as much as process measures, and patient experience and access measures are weighted 1.5 times as much as process measures. CMS assigns a weight of 1 to all new measures. The Part C and D quality improvement measures receive a weight of 5 to further reward contracts for the strides they made to improve the care provided to Medicare enrollees.

Highlights of Contract Performance in 2017 Star Ratings^[1]

Changes in Ratings from 2016

• Approximately 49 percent of MA-PDs (178 contracts) that will be active and rated in 2017 earned four stars or higher for their 2017 overall rating.
• Weighted by enrollment, close to 68 percent of MA-PD enrollees are in contracts with four or more stars.
• The number of active and rated contracts, and the percent of MA-PD enrollees weighted by enrollment in contracts with four or more stars in 2017 is approximately the same in 2017 as compared to 2016.
• In 2017, weighted by enrollment, over 90% of MA-PD enrollees are in contracts with ratings of 3.5 or more stars.

Table 1: 2014 - 2017 Overall Star Rating Distribution for MA-PD Contracts*

Table 2 details the trend in the average Part D ratings unweighted and weighted by enrollment for PDPs per rating category for the period of 2014 to 2017. The last row details the trend in the average Part D rating weighted by enrollment for PDPs for the same period.

• Approximately 49 percent of PDPs (27 contracts) that will be active and rated in 2017 received four or more stars for their 2017 Part D rating.
• Weighted by enrollment, close to 41 percent of PDP enrollees are in contracts with four or more stars.
• There is nearly a 9 percentage point increase in PDP enrollees in contracts with four or more stars compared to 2016, despite the number of PDP contracts decreasing each year.

Table 2: 2012 - 2017 Part D Rating Distribution for PDPs 

* The average Star Rating is weighted by enrollment.

5-Star Contracts

23 contracts are highlighted on MPF with a high performing (gold star) icon: 14 are MA-PD contracts (Table 3), 3 are MA-only contracts (Table 4), and 6 are PDPs (Table 5).

The 12 new 5-star contracts for this year are:

• KS Plan Administrators, LLC (H0332)
• BCBS of Massachusetts HMO Blue, Inc. (H2261)
• Aultcare Health Insurance Corporation (H3664)
• Physicians Health Choice of Texas, LLC (H4527)
• CDPHP Universal Benefits, Inc. (H5042)
• Optimum Healthcare, Inc. (H5594)
• Kaiser Foundation HP, Inc. (H6052)
• Anthem Insurance Co. & BCBSMA & BCBSRI & BCBSVT (S2893)
• Excellus Health Plan, Inc. (S3521)
• BCBS of Michigan Mutual Insurance Company (S5584)
• Wellmark IA & SD, & BCBS MN, MT, NE, ND,& WY (S5743)
• Dean Health Insurance, Inc. (S9701)

Table 3: MA-PD Contracts Receiving the 2017 High Performing Icon

*An EGHP is a non-Employer Group and Employer Group Health Plan.

Table 4: MA-only Contracts Receiving the 2017 High Performing Icon^[2]

 

Table 5: PDP Contracts Receiving the 2017 High Performing Icon

Low Performers

There are 2 contracts identified on the MPF with the Low Performing Icon (LPI) for consistently low quality ratings as detailed in Table 6. Both contracts are receiving the LPI for Part C summary ratings of 2.5 or fewer stars from 2015 through 2017.

Table 6: 2017 Contracts with a Low Performing Icon (LPI)

*These contracts are eligible for termination at the end of 2017. 

Tax Status and Performance

Organizations that are non-profit tend to receive higher ratings than those that are for-profit. For MA-PDs, approximately 70% of the non-profit contracts received four or more stars compared to 39% of the for-profit MA-PDs. Similarly, for PDPs approximately 63% of non-profit PDPs received four or more stars compared to 24% of the for-profit PDPs. Non-profit organizations also performed better than for-profit organizations last year.

Below is the ratings distribution by tax status for MA-PD (Table 7) and PDP (Table 8) contracts.

Table 7: Distribution of Overall Star Ratings for For-profit and Non-profit MA-PDs

Table 8: Distribution of Part D Ratings for For-profit and Non-profit PDPs

Length of Time in Program and Performance

On average, higher Star Ratings are associated with more experience in the MA program. We see a similar pattern for PDPs. The tables below show the distribution of ratings by the number of years in the program (MA-PDs are shown in Table 9 and PDPs in Table 10).

Table 9: Distribution of Overall Star Ratings by Length of Time in Program for MA-PDs

Table 10: Distribution of Part D Ratings by Length of Time in Program for PDPs

Performance of Contracts Eligible to Receive Low Income Subsidy (LIS) Auto-assignees

Most contracts with a Star Rating and eligible to receive LIS auto-assignees (LIS contracts) continue to earn a Star Rating of 3 or more (Table 11).

• Approximately the same percentage of contracts earned a Star Rating of three or more in 2017 compared to 2016.

Table 11: Distribution of Part D Ratings for PDPs Eligible to Receive LIS Auto-assignees

Geographic Variation

The following eight maps illustrate the average Star Ratings weighted by enrollment per county for MA-PDs and PDPs across the U.S., including territories, between 2014 and 2017.[3] These maps exclude the employer group health plans. Counties shaded in green indicate that the average overall Star Rating weighted by enrollment in the county for MA-PDs or average Part D rating for PDPs is four or more stars. Counties shaded in yellow indicate that the average rating weighted by enrollment for the county for MA-PDs or PDPs is three stars. Areas shaded in orange indicate that the average rating weighted by enrollment is less than three stars. Areas in gray indicate data are not available for those counties. Among the changes and updates are:

• The availability of highly rated MA-PDs has increased since 2014.

• The MA-PD maps for 2017 compared to 2014 show the distribution of Star Ratings across the country shifting toward higher rated plans as compared to 2014.

• The PDP map for 2017 compared to 2016 shows that there is a shift in the distribution of Star Ratings across the country and a large increase in the number of plans with four or more stars (regions represented by darker shades of green).
• In 2017 the average rating weighted by enrollment for PDPs across the county is at least three stars.

Average Star Rating for Each Measure

Below we list the average Star Ratings for 2014, 2015, 2016, and 2017 Part C and D measures (Tables 12 and 13). In general, Star Ratings have gone up from 2014 to 2017 for most measures.^[4] 

Table 12: Average Star Rating by Part C Measure

 

Table 13: Average Star Rating by Part D Measure for MA-PDs

Table 14: Average Star Rating by Part D Measure for PDPs

 

Attachment A – 2017 Star Ratings Measure Changes

Below are some additional changes to the 2017 Star Ratings in terms of the measures included.

Specification Changes

• Part C & D measures: C30 – Plan Makes Timely Decisions about Appeals, C31 – Reviewing Appeals Decisions, and D03 – Appeals Upheld: updated each to change re-opening deadline from April 1, 2016 to May 1, 2016.
• Part D measure D03 – Appeals Upheld: removed exclusion for hospice stay.
• Part C & D measures: C28 & D06 – Beneficiary Access and Performance Problems: return to its normal weight of 1.5.
• Part C & D measures C29 – Health Plan Quality Improvement and D07 – Drug Plan Quality Improvement: the CAHPS low reliability “hold harmless” rule has been implemented for contracts affected by very low reliability exclusion of enrollees with less than 6 months in the 2015 survey.
• Part C measure C29 – Health Plan Quality Improvement: added the following measures to the calculation (C01 – Breast Cancer Screening, C26 – Complaints about the Health Plan, C30 – Plan Makes Timely Decisions about Appeals, and C32 – Call Center – Foreign Language Interpreter and TTY Availability).
• Part D measure D07 – Drug Plan Quality Improvement: added the following measures to the calculation (D01 – Call Center – Foreign Language Interpreter and TTY Availability, D03 – Appeals Upheld, D04 – Complaints about the Drug Plan, and D15 – MTM Program Completion Rate for CMR).

Additions

• None

Transitioned Measures

Transitioned measures are measures that have moved to the display page which can be found on the CMS website at this address: http://go.cms.gov/partcanddstarratings

• None

Retired measures

• None
  

Attachment B – 2017 Interim Analytical Adjustment for Socioeconomic Status

As announced in the final 2017 Call Letter^[5] and detailed in the Medicare Part C & D Star Rating Technical Notes^[6], CMS implemented an interim analytical adjustment, the Categorical Adjustment Index (CAI). The CAI is a factor that is added to or subtracted from a contract’s overall and/or summary Star Ratings to adjust for the average within-contract disparity in performance associated with a contract’s percentages of beneficiaries with Low Income Subsidy/Dual Eligible (LIS/DE) and disability status. The value of the CAI varies by a contract’s percentages of beneficiaries with Low Income Subsidy/Dual Eligible (LIS/DE) and disability status.

Below are the changes to the 2017 Star Ratings process to incorporate the interim analytical adjustment for socioeconomic status.

• The summary and overall rating calculation formulas were updated to include the CAI adjustment methodology.
• For contracts whose non-employer service area only covers Puerto Rico, an additional adjustment, a contract-level modified LIS/DE percentage, was determined to address the lack of LIS in Puerto Rico to categorize the contracts for the Categorical Adjustment Index final adjustment category.
• For contracts whose non-employer service area only covers Puerto Rico, the weights for the adherence measures (D12, D13 & D14) were set to zero (0) in the summary and overall rating calculations. The weights of the adherences were retained at three (3) for the improvement measure calculations.

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^[1] Changes in the average Star Rating do not always reflect changes in performance since for some measures there have been significant changes in industry performance and shifts in the distribution of scores. The pre-determined star thresholds were removed for the 2016 Star Ratings. Some measures may have greater shifts from 2015 to 2016 compared to other time periods due to the revision to the methodology used to determine the rating.

^[2] The final 2017 Call Letter can be found at:https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf

^[3] The Medicare Part C & D Star Rating Technical Notes can be found can be found on the CMS website at this address: http://go.cms.gov/partcanddstarratings

^[4] Tables contained in this document may not have sums of percentages of 100.00 due to rounding.

^[5] MA-only contracts cannot offer SNPs.

^[6] Comparisons of Star Ratings across years do not reflect annual revisions made by CMS to the Star Ratings methodology or measure set.