87 percent of Medicare Advantage plans on verge of dropping in star rankings: report


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Higher performance cutpoints and lower member rankings mean that just about nine out of 10 Medicare Advantage plans are on the verge of dropping in a number of 2023 star rankings, based on Press Ganey.

An evaluation compared 446 Medicare Advantage health plans’ unofficial 2022 Medicare Advantage Consumer Assessment of Healthcare Providers & Systems data with their CAHPS star rankings and revealed that 87% of Medicare Advantage plans can have a drop in not less than one CAHPS star rating, with the most important challenges coming in maintaining last 12 months’s CAHPS star rankings in three measures: getting needed pharmaceuticals (48%), care coordination (44%) and customer support (44%).

“Declining in star rankings poses serious financial implications, leading to thousands and thousands — and in some cases billions — of dollars that can directly impact member advantages and member retention,” Press Ganey General Manager of Payer Solutions Suzanne Cogan said in an announcement.

Press Ganey, known for its patient satisfaction surveys, is the one organization certified to conduct all Centers for Medicare & Medicaid Services- and National Committee for Quality Assurance-mandated experience surveys. The firm partners with 96% of the nation’s 4.5- to 5-Star Medicare Advantage and Part D plans. Cogan indicated that the firm put out its predicted 2023 cutpoints, case mix adjustments and CAHPS star rankings upfront of CMS star rankings being released this fall to permit providers to get a head start on 2023 strategic planning.

“With a lot riding on quality rankings, like finding available for member incentives and supplemental advantages, the earlier health plans can discover root causes for lower-than-expected results, the quicker they’ll create performance improvement activities for 2024 Star Rankings,” Press Ganey partner Adam Higman said.

The weighting of the CAHPS-related measures star rating doubled with CMS’ May 2020 final rule now in effect. The revised star rankings system places more emphasis on the patient experience. That, Press Ganey said, places added pressure on health plans to give attention to the member experience and access measures from Medicare CAHPS surveys to sustain and improve performance within the rankings.

Eight Medicare CAHPS measures (37% of a plan’s star rating) will move from being weighted from 2 to 4 in 2023: getting needed care, getting appoints and care quickly, customer support, rating of healthcare quality, rating of health plan, care coordination, rating of drug plan, and getting needed pharmaceuticals.

Several senior living operators offer Medicare Advantage plans to their residents, including the Perennial Consortium, which incorporates Juniper Communities, Christian Living Communities, Ohio Living and AllyAlign Health. LeadingAge California and AllyAlign Health also partnered to supply access to Align Senior Health Medicare Advantage plans.

Erickson Senior Living offers Medicare Advantage plans through Erickson Advantage.

American Health Advantage of Utah partners with Mission Health Services, Cascades Healthcare and Sunshine Terrace Foundation to supply assisted living residents access to institutional-equivalent special needs plan advantages.

Several operators in Minnesota previously joined together to supply the Medica Advantage Solution– PartnerCare, which enables members to pick Medicare Advantage I-SNP coverage in the event that they need or are expected to wish the extent of services provided in a long-term care facility for 90 days or more. 

Toledo, OH-based real estate investment trust Welltower also collaborated with CareMore to integrate CareMore’s clinical programs and onsite care models at Belmont Village and SRG Senior Living independent and assisted living communities in Los Angeles and Orange County, CA. The arrangement introduced residents to Medicare Advantage ISNPs offered through CareMore’s partnering health plans, through which CareMore clinicians deliver and manage care.


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