Articles
How Well Will Your Organization Score in the 2022 Star Rating Measures?
published 2021-09-30
Medicare assigns Star Ratings to Medicare Advantage plans annually based on how they score on a host of improvement measures.
For Part C, Star Ratings will be calculated based on how each plan scores in the following 30 measures, listed in order from highest to lowest measure weight value:
Part C Star Rating Improvement Measures |
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Measure |
Measure Type |
Measure Weight |
| Health Plan Quality Improvement | Improvement Measure | 5 |
| Improving or Maintaining Physical Health | Outcome Measure | 3 |
| Improving or Maintaining Mental Health | Outcome Measure | 3 |
| Diabetes Care - Blood Sugar Controlled | Intermediate Outcome Measure | 3 |
| Getting Needed Care | Patients' Experience/Complaints Measure | 2 |
| Getting Appointments and Care Quickly | Patients' Experience/Complaints Measure | 2 |
| Customer Service | Patients' Experience/Complaints Measure | 2 |
| Rating of Health Care Quality | Patients' Experience/Complaints Measure | 2 |
| Rating of Health Plan | Patients' Experience/Complaints Measure | 2 |
| Care Coordination | Patients' Experience/Complaints Measure | 2 |
| Complaints about the Health Plan | Patients' Experience/Complaints Measure | 2 |
| Members Choosing to Leave the Plan | Patients' Experience/Complaints Measure | 2 |
| Plan Makes Timely Decisions about Appeals | Measures Capturing Access | 2 |
| Reviewing Appeals Decisions | Measures Capturing Access | 2 |
| Call Center - Foreign Language Interpreter/TTY Availability | Measures Capturing Access | 2 |
| Breast Cancer Screening | Process Measure | 1 |
| Colorectal Cancer Screening | Process Measure | 1 |
| Annual Flu Vaccine | Process Measure | 1 |
| Monitoring Physical Activity | Process Measure | 1 |
| Special Needs Plan (SNP) Care Management | Process Measure | 1 |
| Older Adult Care - Medication Review | Process Measure | 1 |
| Older Adult Care - Pain Assessment | Process Measure | 1 |
| Osteoporosis Management in Women who had a Fracture | Process Measure | 1 |
| Diabetes Care - Eye Exam | Process Measure | 1 |
| Diabetes Care - Kidney Disease Monitoring | Process Measure | 1 |
| Rheumatoid Arthritis Management | Process Measure | 1 |
| Reducing the Risk of Falling | Process Measure | 1 |
| Improving Bladder Control | Process Measure | 1 |
| Medication Reconciliation Post Discharge | Process Measure | 1 |
| Statin Therapy in Cardiovascular Disease Patients | Process Measure | 1 |
For Medicare Part D plans, the following 12 Measures will be used for the Star Rating Program in 2022:
Part D Star Rating Improvement Measures |
||
Measure |
Measure Type |
Measure Weight |
| Drug Plan Quality Improvement | Improvement Measure | 5 |
| Medication Adherence for Diabetes Medications | Intermediate Outcome Measure | 3 |
| Medication Adherence for Hypertension (RAS antagonists) | Intermediate Outcome Measure | 3 |
| Medication Adherence for Cholesterol (Statins) | Intermediate Outcome Measure | 3 |
| Statin Use in Persons with Diabetes | Intermediate Outcome Measure | 3 |
| Call Center – Foreign Language Interpreter and TTY Availability | Measures Capturing Access | 2 |
| Complaints about the Drug Plan | Patients' Experience and Complaints Measure | 2 |
| Members Choosing to Leave the Plan | Patients' Experience and Complaints Measure | 2 |
| Drug Plan Quality Improvement | Patients' Experience and Complaints Measure | 2 |
| Rating of Drug Plan | Patients' Experience and Complaints Measure | 2 |
| Getting Needed Prescription Drugs | Patients' Experience and Complaints Measure | 2 |
| MPF Price Accuracy | Process Measure | 1 |
| MTM Program Completion Rate for CMR | Process Measure | 1 |
Noticeable within these measure types are the many "patients' experience and complaints measures," which directly correlates with how the plan engages directly with the member. Reassuring them your organization is here to help them identify needs, maximize plan benefits to address them, and is ready to answer any questions will help to alleviate concerns over how they will afford the type of care they need to ensure a healthier life. Some ideas on member engagement may include:
- Establishing an open line of communication and ensuring communication is through a member-preferred mode (e.g., email, text, phone).
- Educating the member about their benefits, including telehealth options.
- Offering assistance with finding a reputable and compassionate primary care provider to help them manage any and all health care issues. It is important for them to know that even when seeking diagnosis and treatment for specialty-specific health concerns, their primary care physician is overseeing them as a whole person, not just a specialty-specific area.
- Helping members identify and overcome appointment barriers and coordinate any in-home testing, lab work, transportation, or telehealth services available to them.
