Medicare Stars Ratings are Down Across the Industry: Tactics Payers Can Use to Improve Them

The 2023 Medicare stars ratings were recently released by the Centers for Medicare and Medicaid (CMS). The overall finding is that star ratings are on the decline across the industry, which is largely due to pandemic allowances being removed and the change in weighting on member experience. Here’s a review of the results, changes, and what health plans can do to adapt.

Topline Results

  • Average overall ratings (by contract v. population) fell from 4.08 to 3.83 stars
  • 5-star plans fell from 74 to 57 contracts
  • 3-star plans rise from 28 to 90 contracts

Measure Level Results

  • Preventive care has likely bottomed out
    • Breast cancer screening dipped <1%, but is it down >4% from 2021
    • Blood sugar control is up more than 2%; but, still down from 2021
  • Patience has been replaced with frustration as access and labor issues linger
    • After small rises in 2022, CAHPS measures are down
    • Getting care quickly is down 1.68%
    • Customer service is down 0.69%
    • Complaints are up from 0.21 to 0.30

Changes in 2023

  • More focus on patient experience
    • 16 different measures all going up to 4-point weighting each including CAHPS measures
  • Taking away COVID-19 allowance leads towards more stability but more drops in stars
    • COVID-19 allowances and carryovers limited to HOS data items that include 2021 data
  • New guardrails for non-CAHPS measures will make cut points more stable
  • Medication adherence measures remain stable
  • CMS telegraphing interest in Health Equity
    • Anticipating Health Equity Index and SDoH assessment measure in the future

With star ratings down across the board, here are three tactics health plans can use to increase their ratings.

Start CAHPS communications early and often

Better CAHPS survey scores directly translate to better stars ratings – especially with the increase in the member experience weighting. Starting CAHPS communications a month before the survey goes out, is too late. To create informed, satisfied, and loyal members, put a coordinated CAHPS communications strategy into place throughout the year.

Educate members on their benefits

We’ve heard time and again from Medicare panel members they want more communications from their plan on the benefits they have and how they can use them. Additionally, multiple Medicare panelists reported they had never heard of a rewards program, but they would use it AND it would make a plan more attractive. With the high cost of living and many in this group on a fixed budget, any extra rewards to help offset inflation go a long way.

With the ongoing labor shortage, patients have to endure longer wait times when seeking care from physicians and in particular, specialists. Be transparent with your members about this and other areas of discontent. Frame it in a way they can feel ownership in the system and give them alternative access to care options when available such as telehealth services.

Invest in consumer-centric technology

The younger cohorts of the Medicare population have been using technology at their jobs and in their personal lives for decades. They expect and want the same personalization and technology options they have access to in other industries like retail. Now’s the time for health plans to increase investments in consumer-centric technology. This technology should standardize data fields, collect longitudinal records, collect and use channel preferences, as well as create a way to enact Next Best Action when a member calls into the call center. Additionally, with CMS placing importance on health equity and SDoH assessments, technology should include how to collect, store, and effectively use SDoH member data.

There’s a new focus on consumer experience. When health plans invest in these tactics, they can effectively increase member satisfaction – and their star ratings.

Jack Newsom
  • Jack Newsom

During a 25-year career in healthcare, Dr. Newsom has specialized in building teams focused on improving consumer engagement with an emphasis on integrating communications, analytics, and delivery. At Engagys, Dr. Newsom continues the practice of using analytics to drive better health outcomes and improve the results of consumer communications. Additionally, he has led the Healthcare Consumer Engagement Practices survey since its inception in 2017. As Chief Program Officer at Caravan Health, Dr. Newsom lead a team of more than 40 professionals across analytics, quality, events, content management, and delivery to help practices succeed in accountable care frameworks. Prior to that, he created the analytics functions at Silverlink Communications and CenseoHealth. Dr. Newsom holds a bachelor’s degree in Economics, Master of Business Administration, and Master of Science in Clinical Evaluative Science from Dartmouth College, as well as a Doctor of Science in Health Services Research from Boston University where he taught at the School of Public Health for five years.