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This summer has been a whirlwind for Stars ratings. Following the recent decision from the Center for Medicare and Medicaid Services (CMS) to recalculate final Stars ratings and cut points for Star Year (SY) 2024, it is essential for all plans to use this updated information to reforecast their SY2025 performance. With SY2025 measure level execution and submission now closed, all plans eagerly await the first glimpse of their final performance.
What to Expect
Every year, CMS releases results according to the following timeline, typically during the first week or second week of each month.
- Early August: Plan Preview 1 (PP1) – Contract Measure-Level Scores (CAHPS base group cut points also released by CMS in early August)
- Early September: Plan Preview 2 (PP2) – Star Ratings by Measure, draft cut points, embargoed contract year end scores
- Early October: Final Rating Release – Public Overall Rating, Final Technical Specifications and Industry Results/Trends
What You Should Do
As the results are released, there are some key strategies and factors to keep in mind:
- Assemble your data war room immediately - When PP1 is released, it is critical that plans monitor each rate to validate their overall performance. If a rate is inaccurate and needs to be challenged, it should be submitted to CMS during PP1 (This is especially true of the Call Center measures).
- Conduct contract reforecasting session - When plan preview reports are distributed, health plans should update forecasted cut points and examine targets established for each measure. Having more accurate data points from CMS allows plans to develop a more pointed approach to improve the quality rating at the measure-level and quality improvement (QI) measures for the following Star Year.
- Start executing your year-end push NOW – Once targets have been updated, there is no time like the present to execute. Alongside updating targets, health plans should develop a Math Path to update measure level targets and complete strategic blitz activities to close out the plan performance year.
- Communication is key – Make sure you have facilitated a feedback loop with the key business units and leaders of the organization to understand where your performance rating for SY2025 is ending and what support is needed to achieve Stars rating goals set for SY2026.
Next Steps
Stay tuned for ProspHire’s key insights into each Plan Preview Update from CMS. If your plan’s performance isn’t meeting expectations or you need assistance with a deeper data analysis, our Stars Performance experts are here to help with recommendations for improved strategies.
