Shifting Star cut points and how health plans can avoid surprises

Are you confident of what  your plan’s rating will be when the Star Ratings are released this year? For the 2018 Star Ratings, 76 contracts missed a 4-star rating due to the shift in cut points. Some plans might have been prepared for the potential of coming up short. But for many plans, this was likely a surprise. It may have led to some headaches in the days following the release of the new ratings. Not achieving your Star Rating goal can impact the perception that beneficiaries have about the quality of your plan. It can also have a significant impact on revenue that can help provide a stronger benefit for enrollees.

So what can plans do to prevent this type of surprise when CMS releases the new cut points for a measurement year? Many plans measure performance against the latest cut points. Or they add a buffer to those cut points to provide a little bit of padding in case of a shift. Without visibility into how the industry is performing, it can be difficult to predict where the cut points will land. And it can be extremely difficult to plan for significant changes. In the 2018 ratings, we saw a significant shift in cut points for seven measures.

At Optum®, we realize this is a major challenge for health plans. We have been working towards a solution to help mitigate the risks that plan face by using historical cut points. The data assets that run through the Optum Quality engine contain about 60 percent of the of the Medicare Advantage membership. Leveraging these assets, we developed predictive cut points that provide insight into industry performance during the measurement year. The predictive cut points are updated monthly. Historically, we have seen greater than 90 percent accuracy compared to the rates released by CMS. This visibility into industry performance can help plans adjust their strategy during the measurement period. It can also increase confidence levels when closing out a measurement period.

Want to learn more? Register for the webinar.


About the Author:

Wes Morris is a clinical and quality leader with more than 10 years of experience across multiple health care companies and quality functions.

Wes leads the Optum Stars Management Reporting Platform, which empowers health plans to make informed decisions regarding where the organization can affect the care, services and satisfaction being received by members in order to close quality gaps and achieve plan goals. He is responsible for leading overall product direction and client product delivery.

Prior to joining Optum, Wes served as a service and operations program manager in the Stars organization at Humana

Leave a Reply