Five questions with Vanita Pindolia: What you can do to boost Medicare Star Ratings

In a November-December article, we reported about our 2022 Medicare Star Ratings performance. We wanted to take a deeper dive into the subject, so talked with Vanita Pindolia, our Medicare Star Ratings vice president, to get some additional information we thought might be helpful to physicians and their staff.

1. Can you give us a brief refresher of what Star Ratings are and how they’re developed?

   The Centers for Medicare & Medicaid Services developed the Medicare Star Ratings program to help consumers compare Medicare Advantage health plans based on quality and performance. CMS rates the quality of service delivered by health plans — and the care delivered by health care providers — using a 5-star rating scale, with 5 stars indicating the highest score. As you may recall, our 2022 Star Ratings performance was impressive, but there’s always room for improvement.

2. How does CMS determine the ratings of a particular health plan?

   There are approximately 40 measures in the Star Ratings framework, spanning the five Star categories listed below. Each measure is assigned a weight, ranging from 1 to 4. As CMS assigns new weights to metrics each year, the impact of each category on the overall Star Ratings changes. For example, several years ago, the HEDIS^® Category was weighted at 25% of overall Star performance, but in 2021, it only represented 12% of the total rating as CMS placed a greater emphasis on metrics related to patient experience.

   The ratings include measures that assess the perception that our members — your patients — have of their clinical experience, as well as operational measures. To best capture a range of quality metrics, CMS uses various data sets for each Star category, including (but not limited to) the following:

   • Health Effectiveness Data and Information Set, or HEDIS^® — HEDIS data reflects the care delivered by providers and staff, as well as clinical outcomes.
   • Prescription drug event data — This information is collected by health plans to provide insight into how providers are performing on prescription drug-related measures.
   • Consumer Assessment of Healthcare Providers and Systems, or CAHPS^® — This is an annual survey sent to a random sample of members every spring to measure their experience with their health plan, prescription drug plan, health care provider and office staff. The experience members have with their physicians comprises 50% of the overall CAHPS score. The data gleaned from the survey provides insight into members’ perception of whether they have access to high-quality health care.
   • Health Outcomes Survey, or HOS — This survey is sent every summer to a random sample of members to measure self-reported health status and the quality of their health care. A follow-up survey is sent to these same members two years later to measure any changes in health perception.
   • Operations data from health plans — This information is used to assess the quality of customer service and other services health plans are providing to their members.
3. What role can health care providers play in boosting our Medicare Star Ratings?

   By providing high-quality care to patients in a timely manner, providers play a crucial role in our Star Ratings performance. There are various opportunities for providers to engage with patients to help ensure high-quality and timely care, while helping patients manage their health. Here are several steps provider practices can take to make a big difference in the health of their patients:

   • Promote timely and appropriate screenings, tests and treatment.
   • Provide education to staff members for proper documentation of care delivered.
   • Strengthen patient-provider relationships through open communication regarding health care needs and quality of care.
   • Work with patients on developing chronic condition care plans and coordinating care among all the other providers involved with the patient.
   • Follow up with patients about medications and medication adherence.
   • Assess timeliness of care and work with office staff to help ensure that patients can get appointments when they need them.
4. How can taking such steps benefit older patients?

   These practices promote patient safety, preventive medicine, early disease detection and chronic disease management, all of which are especially beneficial for the Medicare Advantage population.

5. How can my staff and I find out more about Star Ratings measures?

   I would recommend you check out our Star Measure Tips, a series of tip sheets on select Star measures that we recently updated for 2022. They’re posted on the Clinical Quality Corner page of web-DENIS. You can get there by following these steps:

   1. From the homepage of web-DENIS, click on BCBSM Provider Publications and Resources in the left column. (You can also access them from the BCN Provider Publications and Resources section of web-DENIS.)
   2. Click on Newsletters & Resources.
   3. Click on Clinical Quality Corner on the left-hand side of the page under Other Resources and scroll down to Star Measure Tips.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.
CAHPS^® is a registered trademark of the Agency for Healthcare Quality and Research.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.