The world of Medicare Advantage (MA) Star Ratings is undergoing a significant transformation for Model Years (MY) 2024 and 2025. These changes, driven in part by the recent focus on health equity and improving quality of care, present both challenges and opportunities for health plans. This blog dives into the key MY2024/MY2025 Star Ratings updates and explores their implications for Quality Improvement (QI), STAR Ratings and Compliance teams at Health Plans. We'll also discuss how technology can play a crucial role in navigating these changes.

• Increased Weight for Physical and Mental Health: The program emphasizes improving/maintaining physical and mental health, with these measures assessed three times a year (3x weight) starting in MY2025. This reflects a growing recognition that mental health is integral to overall well-being. Health plans should start to unlock their claims and clinical data to identify cohorts of Members that could benefit from mental and physical health screenings and interventions.

• New Measure: Kidney Health for Patients with Diabetes: A new measure is introduced in MY2024 to assess kidney health specifically for diabetic patients. This highlights the program's commitment to addressing the unique needs of high-risk populations. Proactive monitoring of kidney function in diabetic patients can help prevent complications and improve long-term outcomes.

• Reduced Frequency of CAHPS & Admin Measures: The burden of CAHPS (Consumer Assessment of Healthcare Providers and Systems) and administrative measures is reduced by collecting them twice a year (2x weight) starting in MY2024. This frees up time and resources for health plans to focus on measures with a greater impact on patient health.

• Elimination of Med Rec Post-Discharge Review: The removal of the post-discharge medical record review requirement in MY2025 allows health plans to streamline processes while still ensuring high quality care. Technology that supports health plans with access to longitudinal member records from their providers’ EHRs can ensure real-time access to necessary member data without the burden of manual reviews.

• New Measure: Concurrent Use of Opioids/Benzodiazepines: The introduction of a measure tracking concurrent use of opioids and benzodiazepines in MY2025 highlights the program's focus on patient safety. Early identification of such cases can help prevent potential adverse interactions and overdoses.

• Expanded MTM Criteria and Reintroduction to Display: The expansion of Medication Therapy Management (MTM) criteria and the return of MTM information display in MY2025 underscores the program's commitment to optimizing medication use. With access to consolidated longitudinal member records, health plans can run analytics to identify members who would benefit most from MTM interventions, such as those with polypharmacy or high-risk medications.

To successfully navigate the evolving Star Ratings landscape, Health Plans should consider the following steps:

1. Conduct a thorough gap analysis: Assess your current capabilities against the new Star Ratings requirements. Identify areas where your processes or data collection and curation might need improvement.
2. Develop a data-driven strategy: Leverage a robust health data management platform like Health Chain's Centaur Data Platform to ensure full and complete access to all data from FHIR and non-FHIR sources to gain insights into your population and identify opportunities for improvement.
3. Implement targeted interventions: Based on real-time analytics, develop targeted interventions to address specific member needs and improve performance on relevant measures at both the individual member and population levels.
4. Invest in care coordination tools: Foster collaboration between care teams to ensure timely interventions and improve overall member health.

Automate compliance tasks: Utilize tools to automate data quality checks, such as Data Observability modules, as well as NCQA-validated technology providers to ensure your team can confidently use the data being made available for quality improvement operations.

The road to Star Ratings success is a continuous journey. By adopting a data-driven approach and leveraging the right technology, Health Plans can not only achieve higher ratings but also foster a culture of continuous improvement that translates into better health outcomes for their members.

These Star Rating program changes necessitate adjustments to Health Plan operations. Health Chain understands the challenges and opportunities presented by the evolving Star Ratings program. Our comprehensive suite of solutions, integrated with our Centaur Data Platform, empowers Health Plans to excel in this environment. Here's where Health Chain can propel your Health Plan to higher star ratings:

• Real-Time Member Profiles: HC’s Centaur Data Platform provides health plans with real-time longitudinal member records comprised of claims data, clinical data, HEDIS measures data, etc., to enable quality teams to play a more proactive role in managing the quality-of-care members receive at the member, provider and population level.
• Proactive Risk Stratification: HC RiskRevPro uses AI/NLP to analyze vast amounts of member data to identify individuals at risk of poor health outcomes or needing specific interventions related to new measures like kidney health for diabetic patients or concurrent use of opioids/benzodiazepines.
• Performance Monitoring and Improvement: HC Value Based Care allows for continuous monitoring of Star Ratings performance all the way down to the individual measure and member level. Health Plans can track progress on new measures, identify areas for improvement and proactively collaborate with providers to refine their strategies over time.

Ready to Take the Next Step?

Contact Health Chain today to learn more about how we can help your Health Plan navigate the new Star Ratings landscape and deliver exceptional care to your members.

Together, we can build a future of better health for all.