In 2007, the Centers for Medicare & Medicaid Services (CMS) established the 5-Star Quality Rating System to measure how well providers and MA plans provide service to members. The main goals are to incentivize insurers to heighten performance and to help patients compare (and ultimately choose) high-quality plans.
The system itself is comprised of 47 quality measures divided into six categories, each with a different weighting. Scores are added together with the weighted average becoming the overall Star Rating. Ratings range from one to five Stars—one Star signals poor performance; five mean excellent performance.
The rating system includes three key areas:
- Performance measures from the Healthcare Effectiveness Data and Information Set (HEDIS)
- Member satisfaction scores (Consumer Assessment of Healthcare Providers and Systems or CAHPS)
- Results of a health outcomes survey (HOS) to its own data
In May 2020, CMS announced key changes to the MA Star Ratings formula for the contract year 2021, which impact 2023 Star Rating scores. The changes spotlight CAHPS surveys… or member satisfaction scores. CAHPS scores will be quadruple-weighted - meaning they'll represent 32% of the overall Star Rating weighting for the contract year 2021.
That’s significant, as CMS is elevating access to care and patient experience to be equal to outcomes measures.
With home-delivered meals programs, there’s an excellent opportunity to boost Star Ratings. Certain quality measures may be influenced and strengthened with a home-delivered meals program. Consider:
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2021 Part C & D Star Ratings – Medicare
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Source
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Star Weight
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Improving or Maintaining Physical Health
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HOS
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3 – Will be Display Measure in 2022 and 2023 because of COVID-related validity
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Diabetes Care – Blood Sugar Controlled
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HEDIS
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3
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Reducing the Risk of Falling
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HEDIS/HOS
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1
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Rating of Health Plan
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CAHPS
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2 – Will be Quadruple-Weighted in 2023
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Health Plan Quality Improvement
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Star Ratings
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5
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Hospitalizations for Potentially Preventable Complications
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HEDIS
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Display Measure
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Plan All-Cause Readmissions
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HEDIS
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Display Measure
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Of course, it’s well documented that home-delivered meals programs are crucial for meeting the needs of individuals who are struggling with food insecurity and/or a chronic health condition. Research has shown time and again that home-delivered meals improve health outcomes, lower healthcare costs, and improve quality of patient care.
The reality is Star Ratings certainly do count—and more Stars may translate into higher plan enrollment. Milliman reported a 20% increase in the number of MA members enrolled in plans offering meals between 2020 and 2021. The year 2021 marks the first time a majority (59%) of MA members enrolled in a plan offering meals.
According to the Kaiser Family Foundation, more than three-quarters (78%) of MA enrollees were in plans with quality ratings of 4 or more stars in 2020—representing a 72% increase from 2019. A study published in 2021 showed Star Ratings are associated with improvements in patient outcomes. Researchers found enrollees in higher Star-rated MA plans had some indications of better-quality care, like a 3.4% increase in the use of higher-rated hospitals and a 2.6% reduction in 90-day readmissions.
Without a doubt, there are reasons galore to shoot for the Stars, with a home-delivered meals benefit offering an ideal avenue for achieving higher Star Ratings.
At Mom’s Meals, we partner with Medicare and Medicaid plans nationwide in implementing home-delivered meals benefits aimed at improving health outcomes. Learn more by contacting us today.
Click here to download our whitepaper - Using Nutrition to Enhance Medicare Advantage Star Ratings.
Click here to download our infographic.