The recently released Stars results show another year with a high number of plans achieving at least four-star ratings will continue increasing in 2021. This is great news for Medicare beneficiaries. But as plan operators know, this also means continued pressure to keep up the pace around Star performance.
Each and every year the industry does well as a whole and the thresholds required to achieve or maintain “good” ratings going forward becomes increasingly difficult to attain. This has created an annual cycle of business risk and uncertainty, where small variations in year-over-year program results and effectiveness can have significant implications. The big difference this year, of course, is COVID-19.
How Will Extended Periods of Suppressed Utilization and a Regulatory Pause on Record Collection Change the Results Plans Should Anticipate in 2021?
It is very possible, if not likely, that this next era of Stars measurements will dramatically reshuffle the deck in terms of plan rankings, and that past stars performance will no longer be able to be relied upon to predict future results. We fully expect that the winners and losers this next plan year will be determined by the nature of the programs they historically relied upon for Stars performance, and perhaps more importantly those individual plans’ ability to adjust and re-calibrate those programs to maximize results in this unprecedented pandemic era.
It is very possible, if not likely, that this next era of Stars measurements will dramatically reshuffle the deck in terms of plan rankings
In our work with Medicare Advantage teams across the country over the past decade, we consistently have seen three distinct strategies deployed, usually in some combination with one another, to achieve Stars performance. However, each of these has shown distinct vulnerabilities in 2020.
First, provider-oriented interventions (annual provider bonus programs or gap-closure drives and campaigns pointed at fee-for-service, or FFS, providers) are often a key driver of Stars performance for network-based plans. These programs were challenged by both provider office closures and the hesitancy of members to seek in-office care during COVID-19. It’s unclear if preventative care has fully rebounded yet, or how long it will take for that to happen.
Second, consider value-based provider partnerships. Unlike the more transactional provider Stars programs above, value-based provider partnerships were traditionally more likely to contain proactive outreach to members. But this may or may not have continued during the Summer of COVID-19. It is unclear how effective Stars efforts have been as members were still hesitant to receive care, and/or providers had to learn to navigate telehealth for the first time. Many leading Plans historically delegated the management and review of these programs to their provider-partners. However, this has, in many cases, created an over-dependency. And how these programs were impacted by COVID-19 and what that might do for Stars performance has become an unsettling blind spot for the year ahead.
Third, consider plan-driven/member-oriented interventions. Many of these types of interventions here were shut down during COVID-19 (for example, in-home assessments), while others may have been a valuable way to reach out to members, show empathy, and build trust (like sending post-cards and mail-out resources). However, gap closure impacts of these strategies ultimately will have been limited along with the decline in in-office care.
The Question every Medicare Advantage Plan Should be Asking is: What's the Right Combination of these Approaches for our Particular Market/Plan Today?
We suspect that both member health status and member healthcare behaviors and sentiments have meaningfully changed as part of COVID-19. Members with underlying chronic conditions may have foregone necessary maintenance care. And preferences around telemedicine versus in-office care have changed and likely have not stabilized to a full “new normal” yet. Furthermore, underlying levels of fear, anxiety, and depression may remain for a while, continuing to impact health status and definitely impacting member engagement and satisfaction ratings. These factors will change the nature and volume of care gaps that plans need to address in 2021 and meaningfully impact the success of any of the three strategies outlined above.
It is critical that plans re-assess their Stars starting point and the impact of any of their strategies for the year ahead. For one plan, the right strategy might be continuing to lean heavily on provider partnerships and focusing on clinical gaps. For another, the answer might be to increase home-mailed or convenient test kits (such as fecal occult blood tests, or FOBT) and think about how to optimize telemedicine to support gap closure and create broader moments for relationship-building with members.
So what should Medicare Advantage leaders be doing today? Current Stars programs absolutely need to be re-evaluated with a keen eye towards skepticism and change — whether that's to maintain current competitive positioning or to opportunistically create a step-change in Stars performance as the competitive tides shift. As discussed above, all Stars program strategies are at risk given the new normal that COVID-19 poses. Leaders need to understand and assess the impact of their current provider efforts, the sentiment of their membership today, and the associated exposure/risk of existing Stars strategies. Though the full Stars year is still ahead, leading plans are taking the time now to rapidly evaluate and shift their focus and resources to more COVID-19-proof Stars strategies that will deliver results for 2021 and beyond. Work must begin now in order to allow ample time for assessing, planning, and the execution of refined strategies.