Welcome to Season 1, Episode 6 of the Soaring to New Health Podcast.
This episode is The Stars are Aligned. We’re diving deep into the world of healthcare and performance improvement. Medicare Stars and its far-reaching implications – what it is, why it’s important for health plans and members, common challenges and successful strategies. Dan Weaver, Senior VP of Stars and Quality at Zing Health and Andrew Bell, Stars Performance Leader at ProspHire.
Medicare Star Ratings are a way to measure and compare the quality and performance of Medicare Advantage and Prescription Drug Plans. The ratings are based on a scale of one to five stars, with five being the best, and they reflect various aspects of the plans such as customer service, patient outcomes, preventive care and benefits. Medicare beneficiaries can use the ratings as a guide when choosing a plan that suits their needs.
In Medicare Stars Plans, there are three categories based on the quality ratings on the plans: plans that have lost their rating, plans that have maintained their rating and well-positioned plans. For those that have lost their rating, recommended strategies include both foundational elements if identifying and addressing the deficiencies and implementing robust processes for advanced analytical components.
Dan Weaver says preparedness is the key. Gather your resources to collaborate and review and compare interpretations, seek outside expertise to help you align on steps that focus on sustainable improvements in quality and continuously monitoring and improving performance. The challenges to successful Star ratings are going to be different for every plan – from resource constraints to provider network challenges to data accuracy and documentation. Addressing these requires a comprehensive and targeted approach, including strategic planning, investment in resources, collaboration with stakeholders and a commitment to continuous quality improvement.
It’s crucial to understand that, at any given moment, your plan is influenced by activities spanning three distinct Star years. Approximately a year before the service dates, HOS surveys are conducted. These service dates take place within a calendar year. The subsequent year involves operational impacts, encompassing CAHPS survey, TTY foreign language testing and other pertinent assessments.
The Medicare Stars Program is highly regulated by CMS and it is common to see modifications to the program, be it measures added or removed, calculation adjustments or weighting changes. Looking ahead, CMS proposed to reduce the weight of patient experience/complaints and access measures from 4x to 2x for the 2026 Star Ratings.
For the more in-depth discussion on Stars Performance Improvement download the Soaring to New Health podcast, The Stars are Aligned, where you find your podcasts.
