IQR CMS Measures for FY 2024 Author: HSAG Subject: CMS Hospital IQR Program Measures for the FY 2024 Payment Update Keywords: CMS Hospital IQR Program Measures for the FY 2024 Payment Update Created Date: 1/14/2022 11:20:47 AM Osteoporosis is responsible for an estimated two million broken bones per year, yet nearly 80% of o, Learn how to improve health equity with better data collection and targeted member engagement. CMS Star Moving the cut lines higher would lead to lower Star Ratings for some insurers. Further Reading: Beginning in 2024, D-SNP HRAs will require screening for food, house, and transportation as part of the 2023 Final Rule. Ashley McNairy The 2022 Star Ratings are inand many health plans should be happy with the results. First, CMS is removing the guardrails to enable true measurement of performance without penalizing plans due to COVID-19. The health equity index award can increase a Medicare Advantage plans overall Star Rating based on a formula that includes the risk factor score and the number of individuals in the social risk factor group. Kidney Health Evaluation for Patients with Diabetes, Concurrent Use of Opioids and Benzodiazepines, Polypharmacy, Use of Multiple Anticholinergic Medications in Older Adults, and Polypharmacy, Use of Multiple Central Nervous System Active Medications in Older Adults. Copyright 2023. To submit comments or questions electronically, go to, , enter the docket number CMS- 2023-0010, in the search field, and follow the instructions for submitting a comment.. CMS designed the clause so plans with high star ratings wouldnt be penalized should low improvement measures lower their score. Lower Star Ratings would reduce bonus payments, rebates, and supplemental benefits offered to beneficiaries. WebEach measure is awarded a star rating and the individual measure stars are then aggregated at the domain and summary level. Learn five best practices for shifting from a retrospective HEDIS strategy to a proactive in-year strategy, enabling plans to boost scores and member engagement. 19: 2021 Medicare Advantage Star Ratings Changes and CAHPS Improvement, Adhere Health (December 3, 2020), https://adherehealth.com/2021-medicare-advantage-star-ratings-changes-and-cahps-improvement/. measures will move to the display page for the 2024 and 2025 Star Ratings and return to the 2026 Star Ratings with a weight of one (1). However, the short-term impact overall is minimal in 2022 and 2023. Individual plans experience will vary. This growth rate is largely driven by the growth in Medicare Fee-For-Service (FFS) per capita costs, as estimated by the Office of the Actuary. Plans are rated on a one-to-five scale, with one star When will the changes included in the Contract Year 2024 Medicare Advantage proposed rule become effective? It would include those who receive low-income subsidies, those dually eligible, and those with a disability as the social risk factor group to be measured. Over the last several years, CMS has increased the Patients Experience and Member Complaints Star Rating measure weights from 1.5 to 4, reinforcing the focus on and commitment to Although the trend for more challenging Star cut points each year is not new, plans should anticipate the increased difficultly and act sooner rather than later. Contract Year 2024 Policy and Technical Changes to Learn the changes NCQA is proposing for HEDIS Measurement Year (MY) 2024 and MY 2025. This notice contained several proposed changes to both methodology, calculation and future measures. The two Health Outcomes Survey (HOS) outcome measures, Improving or Maintaining Physical Health and Improving or Maintaining Mental Health, which are triple-weighted, assess an MA organizations ability to improve or maintain the physical and mental health of its enrollees over time, based on baseline and follow-up survey data collected at the beginning and end of a two-year period. As a result, CMS said the validity of the models is compromised and it cant accurately measure change in beneficiary health status over time for these two measures. 80% of low-income households that qualify for reduced-rate broadband access dont realize it. The Journey to 4-Star Performance: How Data Analytics Make the Difference. 2024 For example, 2024s Star Ratings use data from the 2022 measurement year. Established by the Centers for Medicare & Medicaid Services (CMS), QualityNet provides healthcare quality improvement news, resources and data reporting tools and applications used by healthcare providers and others. CMS Cotivitis Quality Intelligence clients saw impressive results in the 2022 Star Ratings, many improving their overall rating significantly: But even as we celebrate strong ratings for 2022, health plans should be aware of how they achieved this success and keep an eye on upcoming changes for 2023 and 2024. The first reason for the increase in Star Ratings is the better of methodology. Approximately 90 percent of people currently in Medicare Advantage plans that offer prescription drug coverage are enrolled in a plan that earned four or more stars in 2022. The overall rating is the weighted average of a plans HEDIS and CAHPS measure ratings, plus bonus points for plans with a current Accreditation status as of June 30, 2023. dropped by almost a quarter of a point after seemingly less significant program modifications. The proposed rule suggests the HEI reward structure begins for 2027 Star Ratings, leveraging data from measurement years 2024 and 2025. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. QRS That 4.0 weight translates to the patient experience measures comprising nearly 60% of the total rating. The Centers for Medicare & Medicaid Services (CMS) released the 2023 Star Ratings for Medicare Advantage (Medicare Part C) and Medicare Part D prescription drug plans to help people with Medicare compare plans ahead of Medicare Open Enrollment, which kicks off on October 15. CMS anticipates that this deletion methodology would create a savings of over $800 million for 2024 and increasing to $1.45 billion in savings by 2030. Medicare Open Enrollment begins October 15, 2021, and ends December 7, 2021. The proposed rule aims to eliminate health disparities in plan performance by SRFs, consistent with CMS efforts to advance health equity. year. We dont take HEDIS updates and changes lightly: Measure development and major updates follow a rigorous process that includes a public comment period and input from experts and stakeholders. In 2022 Medicare Advantage plans will report on two new HEDIS measures for 2024 Star Ratings. top third of all contracts, 0 points to those that score in the middle third of all 4: Trends in Part C & D Star Rating Measure Cut Points, Centers for Medicare & Medicaid Services (February 3, 2023), https://www.cms.gov/files/zip/cut-point-trends.zip. For more information on the 2022 Medicare Advantage and Part D Star Ratings, including a fact sheet, please visit: CMS Office of the Actuary Releases 2022-2031 National Health Expenditure Projections, 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F), HHS Finalizes Rule to Strengthen Medicare, Improve Access to Affordable Prescription Drug Coverage, and Hold Private Insurance Companies Accountable to Delivering Quality Health Care for Americas Seniors and People with Disabilities, Fact Sheet: 2024 Medicare Advantage and Part D Rate Announcement, HHS Updates 2024 Medicare Advantage Program and Part D Payment Policies. CMS regularly reviews and updates the measures used to calculate the ratings and the methodology for determining the ratings. Some measures that may prove challenging in 2023 include colorectal cancer screening (COL), which increased at every star cut point, notably two- and three- star cut points, causing additional challenges for health plans.10 One strategy for health plans would be to include an in-home FOBT/FIT kit to target currently enrolled members that were non-compliant in the prior measurement year with more frequent and high-touch outreach in Q1 2023. The Centers for Medicare & Medicaid Services (CMS) use a five star system to measure Medicare members experience with the health care system; one being The proposed rule has a comment period that ends February 13, 2023, and CMS will likely publish the final rules this summer. Telehealth has always been critical, yet there is an assumption that everyone has access. Those with an overall 4-star rating achieved 5 stars on only 42% of measures. The measures rely on models to predict expected changes in physical and mental health status and mortality from baseline to follow-up, based on relative contract performance. In January 2021, the CMS Final Rule included the following measures in the 2024 Star Ratings calculation as 1x weight each: Transitions of Care and Follow-Up After Emergency While adjustments to the cut points might provide some perspective on the overall market Star Rating performance, it is vital to keep in mind that significant program and regulatory changes are also likely to affect an MAOs Star Rating performance. This calendar summarizes proposed and confirmed upcoming changes to the CMS Star Ratings system for 2024 and beyond to help you stay ahead of measure and policy changes on the WebActual performance decreased so pervasively that the average Part C and D Improvement measure ratings decreased to 2.6 stars and 2.7 stars, respectively. The final 2024 Rate Announcement will be published no later than Monday, April 3, 2023. Measures that are case-mix adjusted in the Star Ratings would employ all Learn how to improve engagement. Adult Immunization Status Across dually eligible members, MA plan materials are not captured in a full suite of languages as compared to Medicaid managed care organizations (MCOs), MA members have had to file separate requests to obtain materials in their preferred language. These barriers prevent non-CAHPS measure cut points from moving more than 5% in each direction.12 Due to the CMS-imposed guardrails, it is important to keep in mind that changes in contract-level performance may have called for a larger cut point movement.