How Well Will Your Organization Score in the 2022 Star Rating Measures?

by  Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
September 30th, 2021

Medicare assigns Star Ratings to Medicare Advantage plans annually based on how they score on a host of improvement measures.

For Part C, Star Ratings will be calculated based on how each plan scores in the following 30 measures, listed in order from highest to lowest measure weight value:

Part C Star Rating Improvement Measures

Measure

Measure Type

Measure Weight

Health Plan Quality Improvement Improvement Measure 5
Improving or Maintaining Physical Health Outcome Measure 3
Improving or Maintaining Mental Health Outcome Measure 3
Diabetes Care - Blood Sugar Controlled Intermediate Outcome Measure 3
Getting Needed Care Patients' Experience/Complaints Measure 2
Getting Appointments and Care Quickly Patients' Experience/Complaints Measure 2
Customer Service Patients' Experience/Complaints Measure 2
Rating of Health Care Quality Patients' Experience/Complaints Measure 2
Rating of Health Plan Patients' Experience/Complaints Measure 2
Care Coordination Patients' Experience/Complaints Measure 2
Complaints about the Health Plan Patients' Experience/Complaints Measure 2
Members Choosing to Leave the Plan Patients' Experience/Complaints Measure 2
Plan Makes Timely Decisions about Appeals Measures Capturing Access 2
Reviewing Appeals Decisions Measures Capturing Access 2
Call Center - Foreign Language Interpreter/TTY Availability Measures Capturing Access 2
Breast Cancer Screening Process Measure 1
Colorectal Cancer Screening Process Measure 1
Annual Flu Vaccine Process Measure 1
Monitoring Physical Activity Process Measure 1
Special Needs Plan (SNP) Care Management Process Measure 1
Older Adult Care - Medication Review Process Measure 1
Older Adult Care - Pain Assessment Process Measure 1
Osteoporosis Management in Women who had a Fracture Process Measure 1
Diabetes Care - Eye Exam Process Measure 1
Diabetes Care - Kidney Disease Monitoring Process Measure 1
Rheumatoid Arthritis Management Process Measure 1
Reducing the Risk of Falling Process Measure 1
Improving Bladder Control Process Measure 1
Medication Reconciliation Post Discharge Process Measure 1
Statin Therapy in Cardiovascular Disease Patients Process Measure 1

For Medicare Part D plans, the following 12 Measures will be used for the Star Rating Program in 2022:

Part D Star Rating Improvement Measures

Measure

Measure Type

Measure Weight

Drug Plan Quality Improvement Improvement Measure 5
Medication Adherence for Diabetes Medications Intermediate Outcome Measure 3
Medication Adherence for Hypertension (RAS antagonists) Intermediate Outcome Measure 3
Medication Adherence for Cholesterol (Statins) Intermediate Outcome Measure 3
Statin Use in Persons with Diabetes Intermediate Outcome Measure 3
Call Center – Foreign Language Interpreter and TTY Availability Measures Capturing Access 2
Complaints about the Drug Plan Patients' Experience and Complaints Measure 2
Members Choosing to Leave the Plan Patients' Experience and Complaints Measure 2
Drug Plan Quality Improvement Patients' Experience and Complaints Measure 2
Rating of Drug Plan Patients' Experience and Complaints Measure 2
Getting Needed Prescription Drugs Patients' Experience and Complaints Measure 2
MPF Price Accuracy Process Measure 1
MTM Program Completion Rate for CMR Process Measure 1

Noticeable within these measure types are the many "patients' experience and complaints measures," which directly correlates with how the plan engages directly with the member. Reassuring them your organization is here to help them identify needs, maximize plan benefits to address them, and is ready to answer any questions will help to alleviate concerns over how they will afford the type of care they need to ensure a healthier life. Some ideas on member engagement may include:

References:

How Well Will Your Organization Score in the 2022 Star Rating Measures?. (2021, September 30). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/2022-star-rating-measures-for-medicare-parts-c-and-d-36879.html

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