BCBS Researchers Discuss CMS’ 2021 Changes to Medicare Star Rating Criteria – AJMC.com Managed Markets Network

Karen Coderre, PharmD, and Madhavi Manduru-Rao, PharmD, detail how CMS’ increased weighting for Consumer Assessment of Health Care Providers and Systems surveys impacts Star ratings.

Karen Coderre, PharmD, is director, Pharmacy Clinical Management and Quality, and Madhavi Manduru-Rao, PharmD, is manager, Pharmacy Quality Programs, at BlueCross BlueShield of North Carolina.

Transcript

What change did CMS make to 2021 health plans, and how do Consumer Assessment of Health Care Providers and Systems (CAHPS) surveys affect various Medicare Star ratings?

Coderre: So, the changes that CMS made for experience in 2021 is they doubled the weight of the member experience rating for Medicare stars. Basically, it used to be double weighted last year score and now it is quadruple weighted. So, because of that, almost one-third of your overall Star rating is going to be impacted by your member experience and access to care, and that’s measured by CAHPS surveys, which Madhavi be can talk about.

Manduru-Rao: It’s always on the back of our mind to make sure that we always keep an eye on [member experience] either through an interaction with a phone call with a member or doing a comprehensive medication review. It’s to make sure that that contact with the member is the best possible and that the member leaves feeling, “I got the answer I wanted,” so when they come back and rate the drug plan or rate the health plan through these CAHPS surveys, hopefully, they will rate us with a higher number based on those experiences.