My FTI colleagues Mark Van Ert and Krunal Patel summarize some of the new quality measures that will be incorporated into the 2025 CMS star ratings used to evaluate Medicare Advantage (MA) plans. CMS star ratings are very important as CMS payments to MA plans are expected to increase by 3.7% or $16 billion between 2024 and 2025.
Van Ert and Patel Describe the CMS qualifications cycle as follows:
Star ratings are determined through a four-year process. The first year is the measurement year (“MY”), in which plans collect performance data for various measures, although the specific timing may vary; For example, Consumer Assessment of Healthcare Providers and Systems (“CAHPS”) surveys are conducted at the outset. of the second year. During the second year, the reporting year (“RY”), CMS evaluates performance data from the prior year. The third year is the Star Year (“SY”), which is when Star Ratings are officially assigned. In the fourth year, the year of the quality bonus payment (“QBP”).4
What are the new measures that will be included by 2025? These include:
- Concurrent use of opioids and benzodiazepines. Evaluates the simultaneous prescription of opioids and benzodiazepines, which significantly increases the risk of respiratory depression and fatal overdoses.
- Use of Multiple Anticholinergic Medications in Older Adults. The measure focuses on the risks associated with older adults taking multiple anticholinergic medications at the same time, which can lead to cognitive decline.
- Kidney health for patients with diabetes. Measures the percentage of members ages 18 to 85 with diabetes (type 1 and type 2) who received a kidney health assessment, including assessments of estimated glomerular filtration rate (eGFR) and a urine albumin-to-creatinine ratio (uACR).
- Improve/maintain physical health. Measures overall physical functioning according to Medicare. Health Outcomes Survey.
- Improve/maintain mental health. It assesses beneficiaries’ self-reported data on emotional well-being, such as the frequency of feelings of depression, anxiety, and other mental health conditions under Medicare. Health Outcomes Survey.
Complete technical specifications for all CMS Star Rating quality measures can be found. here.
