Shifting Measures In Stars—Making The Quick Pivot

In this episode, we discuss the significant changes in the weight of Star measures, with the reversal of the 2022 Final Rule—many measures are returning to their previous weights. In response to the 2022 Final Rule, plans made significant investments to enhance the member experience in areas like customer service and developing digital platforms. The 2023 Final Rule has recently announced the removal of the Reward Factor and is replacing it with the Health Equity Index, which aims to incentivize plans to focus on serving members with higher social risk factors.

“Members are getting a better experience because plans reacted to the measure weight increases. Even though the measure weights may be redacted, the investments are already there and members are going to continue to feel the benefits of these enhancements.” - Michelle Simon

Although the removal of the Reward Factor may temporarily affect Star Ratings, plans that perform well for their underserved members will receive a bonus tied to their performance. 

The point system and measure weights play a crucial role in plan performance for Star Ratings. The difference between a 4-Star and a 5-Star plan is often a very tight threshold. It’s critical for plans to adopt a dynamic approach that constantly evaluates the data and how it relates to the weight of the measures. Stars is a math game that requires constant analysis and iteration to strategically direct efforts and resources towards the highest impact. 

While the upcoming changes are generating a mix of excitement and apprehension among plans, the focus remains on advocating for the members and achieving better outcomes. 

Tune into this episode to hear valuable insights into the challenges and opportunities in the Stars program, and learn strategies in navigating the changes and improving performance.

About Our Guest
Michelle Simon has over 15 years of experience in quality programs. She began her career on the commercial side with the quality rating system and transitioned into the Stars space where she has spent the majority of her career. Simon has a Masters degree in Organizational Leadership and a Post-Graduate Certificate in Healthcare Informatics and Data Analytics.