If you’re a Medicare Advantage Part D (MAPD) health plan, your Star Ratings strategy can make or break you (and your bonus dollars). Trying the same tactics year after year, not adjusting based on previous years’ approach, is a surefire way to fail. Not evaluating your status on an ongoing basis during the year (checking for opportunities to improve, observing member receptivity rates, etc.), is another way to fail. But there are also some less obvious ways we see MAPD plans not meeting their Star Ratings potential.

Star Ratings Fail #1: Being Too Late

Think back to the last few Star Ratings years. When did you start looking at data on things like adherence measures? Was it the end of summer? The beginning of fall? The end of fall? Unfortunately, most MAPD plans do the same thing. They get that lagging prescription drug event (PDE) data from CMS, realize the numbers are careening out of control, and scramble to reach out to hundreds or thousands of members. If this sounds remotely familiar to you, that’s actually a good thing – it means you have a huge opportunity to improve your Star Ratings.

Here’s what you need to know:

  • First, understand the pitfall of past data. Retroactive analyses of PDEs and other data generally misrepresent adherence rates, starting too high at the beginning of the year and then dropping sharply closer to the end of fall.
  • Second, understand the power of predictive data. Using your own near real-time data to project 12 months of adherence and including single and double-fillers, results in precise predictions. (Note: Not all vendors can or will do this, so ask about this up front to be sure you get what you need.)
  • Third, combine analysis with forecasting – at the beginning of the Star Rating year. If you pair historical data (to refine your strategy) with advanced data forecasting (to get a realistic picture of what’s coming), you can affect real, meaningful change.

Star Ratings Fail #2: Being Too Specific

Star Ratings include so many measures and factors, which are changing year-to-year, that it’s easy to become overwhelmed and lean into a more myopic approach. That boxes you in and cuts off a lot of opportunity for growth and gain. Essentially, if you focus too much time, money, or resources on any one element, an imbalance develops and you can’t get ahead.

Here’s a good example of this from our own work:

38% of Star Ratings are impacted by medication use. Imagine a plan focusing all their energy here. If they succeed, they may certainly get trickle-down effects of healthier, happier patients, but they also likely drop the ball in the roughly two-thirds of remaining measures. The goal is to find efficiencies in managing such critical components as medication use to allocate more time across the board to other quality improvement initiatives.

Star Ratings Fail #3: Being Too Broad

The same way your strategy could be “too specific,” it could also be “too broad.” Consider this:

96% of high-performing plans score 4+ stars on medication adherence measures.

To restate the close of the previous point, you shouldn’t focus entirely on measures impacted by medication use, but you should still focus on them. Plans that do well overall tend to do well across the larger categories, too. The key is right-sizing your approach within each category to make it scalable across your member population.

For example, to right-size your approach to medication adherence measures, you need to ensure you incorporate member behavior and the right intervention mix. This enables you to optimize your resources and target members that who need and benefit from tactics like intervention and outreach.

Star Ratings Wins

Developing a strategy is about your data, your plan, and your members. Although there are lessons to be learned across the board by looking at what doesn’t work, the real value comes in customizing and cultivating tactics that work for you.

If you want some help figuring out what that looks like, check out these resources or start a conversation with us directly. Just do yourself a favor – don’t wait until the fall.