9 Out of 10 Medicare Advantage Plans Could Lose a Star in One or More 2023 CAHPS Star Ratings, According to New Press Ganey Analysis

Press Ganey’s member experience expertise to help health plans surpass scoring cutpoints and receive CMS quality bonus payments

BOSTON–(BUSINESS WIRE)–According to Press Ganey, the national leader in patient and member experience and only organization certified to conduct all CMS- and NCQA-mandated experience surveys, 87% of Medicare Advantage health plans are on the verge of dropping in one or more of the CAHPS Star Ratings. These findings are based on preliminary data that reveal the combined impact of higher performance cutpoints and lower ratings from health plan members.

More than eight of the 4-Star cutpoints and five of the 5-Star cutpoints are increasing this year, making it more challenging for plans that were near the threshold to achieve higher Star Ratings for 2023.

Press Ganey predictions for the 2023 ratings signal that a large proportion of MA plans will have the biggest challenge maintaining last year’s Star Ratings in three measures:

48% are at risk of losing a Star on Getting Needed Prescription Drugs.

44% are at risk of losing a Star for Customer Service.

And 44% of plans are at risk of losing a Star for Care Coordination.

“Declining in Star Ratings poses serious financial implications – resulting in millions, and in some cases billions, of dollars – that will directly impact member benefits and member retention,” said Suzanne Cogan, general manager, payer solutions, Press Ganey. “Because we partner with 96% of the nation’s 4.5- and 5-Star Medicare Advantage and Part D plans and have significantly large benchmarks, we’ve predicted 2023 cutpoints, case mix adjustments and CAHPS Star Ratings well in advance of CMS Star Ratings being released this fall.”

With CMS’s May 2020 Final Rule now in effect, the weighting of CAHPS-related measures in Star Rating has doubled – putting added pressure on health plans to focus on member experience and access measures from Medicare CAHPS surveys in order to sustain and improve performance in the ratings.

Several Medicare CAHPS measures that were weighted 2 in 2022 will now be weighted 4 in 2023, making up roughly 37% of a plan’s Star Rating:

Getting Needed Care

Getting Appoints and Care Quickly

Customer Service

Rating of Healthcare Quality

Rating of Health Plan

Care Coordination

Rating of Drug Plan

Getting Needed Prescription Drugs

“Press Ganey has preliminary CAHPS Star Rating results ready for its clients to get a head start with 2023 strategic planning,” said Adam Higman, partner, strategic consultant, Press Ganey. “With so much riding on quality ratings, like funding available for member incentives and supplemental benefits, the sooner health plans can identify root causes for lower-than-expected results, the quicker they can create performance improvement activities for 2024 Star Ratings.”

To schedule a complimentary consultation and uncover whether your Medicare Advantage Plan is at risk, visit PressGaney.com/StarsPrediction.

About Press Ganey’s Analysis

Press Ganey’s analysis depicts findings from 446 Medicare Advantage health plans’ initial preliminary, unofficial 2022 MCAHPS data, comparing the CAHPS Star Rating they currently qualify for against last year’s official CAHPS Star Rating.

About Press Ganey

Press Ganey invented the healthcare performance improvement movement over 35 years ago. Today it offers an integrated suite of solutions that address health plan member experience and engagement, safety, clinical excellence, patient experience and workforce engagement. The company works with health plans in all 50 U.S. states and more than 41,000 healthcare facilities in its mission to reduce patient suffering and enhance caregiver resilience to improve the overall safety, quality and experience of care.

Contacts

Media:
Ty Fiesel

MP&F Strategic Communications

TFiesel@mpf.com
615.259.4000