Here are our predictions for the health care industry in 2022 based on interviews with industry experts in 2021, presentations at RISE conferences, and observations from our editorial team.
A significant push to maintain those unexpectedly high 2022 Star ratings
Many in the industry were caught by surprise this year by the large number of health plans that earned 4 and 5 stars for 2022. Sixty-eight percent (322 contracts) of Medicare Advantage and Medicare Part D prescription drug plans earned 4+ Stars and 74 contracts received a 5-Star overall rating.
Part of the reason for the inflated scores: Due to the COVID-19 public health emergency, all health plans qualified for the Centers for Medicare & Medicaid Services’ (CMS) “extreme and uncontrollable circumstances policy” for the 2022 Star ratings. This meant plans could use the better of the 2021 or 2022 ratings for most measures. The challenge now: maintaining those ratings for 2023 because plans won’t have the same opportunity to choose the better of the ratings going forward.
“As they took the best score for the past two years, health plans did not expect to hit the high water marks they did. With the volume of high fours and fives Star scores, it’s going to be an incredible amount of work to maintain those bonus levels,” industry expert RaeAnn Grossman, executive vice president, operations – risk adjustment, population health management and quality, Cotiviti, told RISE in a recent interview.
Grossman, pictured right, a conference chair for RISE National 2022, predicts that the big trend for 2022 will be “how do we reverse engineer to maintain the 5-Star rating. Driving domains and measures with the greater impacts, such as medication adherence and patient satisfaction.”
Melissa Smith, executive vice president of consulting and professional services at HealthMine, pictured right, agreed, noting during the 12th Annual Star Ratings Master Class in December that chasing “tips and tricks’ from competitors or “best practices” as a pathway to 4+ Stars simply won’t cut it in 2022. The accelerated movement of HEDIS to digital, CMS focus on measures of data interoperability and technological enablement, and emphasis on health equity require different effort and investments in 2022 than in previous years.
Therefore, she said, maintaining high ratings will require careful communication, methodical planning/investment, and leadership awareness of the new needs of Stars.
In a recent column for RISE, Ana Handshuh, principal, CAT5 Strategies and chair of the RISE Quality & Revenue Community, noted trends for 2022 Star ratings and offered suggestions when planning for benefit design, quality programs, operational structure, resource allocation, and future investment.
Among her recommendation: Provide members with options to access their care how, when, and where they want; and offer benefits that facilitate self-direction on members’ own terms to drive higher satisfaction and improved health outcomes.
Additional supplemental benefit offerings, more competition
Grossman is also interested in how those plans with excellent ratings will use their additional quality bonus payments for 2023 benefits. The improved product offerings that result may create an opportunity for the high-ranking plans to acquire new members and retain a significant percentage of their current members.
Indeed, Grossman said it will be difficult for plans that received 3.5 Star ratings and don’t get a bonus to compete in markets that have 4- and 5-Star plans and can use the extra money to improve their benefit offerings. “I think we need to watch and see how many plans actually stay in some of those markets,” she said.
Grossman expects to see new supplemental benefits being added to plans for 2023. The key for plans, however, is making sure the benefits offered meet the needs of the population and geographical area. This year, Grossman said she’s interested to look back to see which benefits currently offered (such as meals, transportation, and over-the-counter medications and supplies) have had the greatest impact on members.
Increased focus on health equity
In an interview with RISE earlier this year, health policy expert Ezekiel J. Emanuel, M.D., former advisor to President Joe Biden’s transition team on COVID-19, said that he expected the Biden administration to address equity and ensure better outcomes among minority and lower income populations during his term. Since then, the word equity has frequently popped up in CMS communications.
Indeed, health equity is the top priority at CMS for Medicare Advantage, the Affordable Care Act, and Medicaid, Smith told attendees at the RISE 12th Annual Star Ratings Master Class. Every decision CMS now makes is through the lens of how a decision or action improves the equity of health care services, she said during her keynote presentation.
CMS Administrator Chiquita Brooks-LaSure said as much in a blog post for Health Affairs, noting that COVID-19 not only put an incredible strain on the U.S. health care infrastructure, it also highlighted weaknesses and disparities in vulnerable populations. In the post, she laid out her strategy for how CMS will achieve its vision to advance health equity, expand coverage, and improve health outcomes. Everything the agency does, she said, should align with one or more of these strategic pillars:
- Advance health equity by addressing the health disparities that underlie the country’s health system
- Build on the Affordable Care Act and expand access to quality, affordable health coverage and care
- Engage our partners and the communities we serve throughout the policymaking and implementation process
- Drive innovation to tackle our health system challenges and promote value-based, person-centered care
- Protect our programs' sustainability for future generations by serving as a responsible steward of public funds
- Foster a positive and inclusive workplace and workforce and promote excellence in all aspects of CMS' operations
CMS has since indicated in the 2022 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule that it is considering future actions to advance health equity based on the feedback it received after the release of the proposed rule. CMS said stakeholders submitted input on ways to make reporting of health disparities based on social risk factors and race and ethnicity more comprehensive and actionable by including additional demographic data points, such as race, ethnicity, Medicare/Medicaid dual eligible status, disability status, LGBTQ+, and socioeconomic status.
And in the recently released proposed 2023 payment notice, CMS announced plans to advance policies to make coverage options for consumers in the Affordable Care Act more equitable.
Meanwhile, the National Committee for Quality Assurance (NCQA) is also working to close the gap on health equity. The organization has called for the “reporting, collecting, and acting on complete, accurate, and reliable data on race and ethnicity” to better identify and act on eliminating disparities and is now offering health equity accreditation to help health systems and health plans to advance health equity. In a fireside chat during RISE National 2021, Frank Micciche, vice president, public policy and external relations, pictured right, said proposed changes would encourage organizations to focus on identifying whether there are disparities within their populations and, if so, to make sure they are able to document and update what they are doing to address disparities.
“Quality care is equitable care,” Micciche said, noting you can’t have high-quality care if there are segments of your community that are underserved.
Micciche will discuss health equity and NCQA’s new accreditation program (as well as the trend below) at RISE National 2022.
A continued push toward digital quality measurement
NCQA has also indicated its support for CMS’ plans to move to all-digital quality measures by 2025.
In its comments to the federal agency, NCQA said “digitizing and automating the processes related to quality reporting, management and improvement can result in better measures, better measurement systems and better data—while dramatically reducing burden.” By building data collection into clinician workflows, the digital measures also reduce the additional work to collect quality data, which will free up clinicians to focus on patient care, NCQA noted. To help push the movement forward, NCQA said it will evolve its measures portfolio to be digital first and have the ability to measure and aggregate quality data across all levels of the delivery system.
Author and health care futurist Ian Morrison, a keynote at RISE National 2021, also referenced in his presentation the huge opportunities ahead for digital innovations, such as consumer applications to enhance the patient and member experience, chronic care and behavioral health applications, post-acute care transitions, population health initiatives, operations 2.0 core systems, and a rise of virtual care capabilities and competitors.
Editor's Note: RISE National 2022 will focus on these trends and others. The annual event will take place March 7-9 in Nashville, Tenn. Click here for the full agenda, list of speakers, registration information, and health and safety protocols.