If your Medicare Advantage plan is finding it more difficult to maintain or raise your current Star rating, don’t miss our three-day Master Class to learn from the best in the industry.
The 15th Annual RISE Star Ratings Master Class heads to Scottsdale, Ariz., Dec. 8-10, where industry experts will discuss the regulatory shifts, legal actions, new quality measures, and intensified focus on the health equity index that has reshaped the Star ratings program. If you haven’t yet attended the Master Class, this is the year you don’t want to miss.
Indeed, speaker Rex Wallace, CEBS, chief executive officer of Rex Wallace Consulting, LLC., plans to bring his entire team to the conference. “To me, there's no more important year to be there than this year,” he says.
Wallace, who will present at three sessions during the Master Class, said this has been a particularly difficult year for Medicare Advantage plans.
“The cut points have moved more than they ever have. The percentage of members in five-Star plans is lower than it’s ever been. The number of plans with the low-performing icon equals the number of plans with the high-performing icon…Just lots of different metrics indicating how hard this year has been and with the reward factor going away and the health equity index coming, it doesn’t appear to be getting any easier in the next couple of years.”
RELATED: 2025 Medicare Advantage Star ratings: Number of 5-star plans continue to drop
Speaker Ana Handshuh, principal, CAT5 Strategies, says Medicare Advantage plans have had trouble maintaining and increasing their scores since they became accustomed to a level of performance that wasn’t sustainable in the Stars program because the quality bonus payments tied to that level of performance was artificially boosted by the COVID flexibilities.
Handshuh, who will present a session on the Star rating changes for 2025 along with Melissa Smith, founder and senior advisor of the Newton Smith Group, says plans got used to that level of performance, which may not have been a reality for a lot of them. “So, plans that have not been gradually tweaking their operations, benefits, and communications post-COVID to position themselves for what it takes to be successful at Stars today, must react much more quickly. Because if they don’t, it will be an existential issue for them. Some plans have already reacted to the new Stars world, and as we’ve seen, they’re the ones driving the cut points.”
In an interview with RISE after the 2025 Medicare Advantage Star ratings were released, Smith also noted that cut points have gone up because national performance is increasing. Of the 35 easily compared measures, national average performance “increased on 26 measures and only decreased on three measures. This increased performance is accounted for in Star ratings via increased cut points. This means that plans not keeping pace with competitors will earn lower ratings, which is precisely the goal of the Star ratings methodology,” she says.
Become nimble and adaptable
Innovative plans have adapted well to methodology and measure changes and as a result, cut points improved, Handshuh explains. This subset of plans did so well that it meant other plans couldn’t keep up with their scores from the prior year. “Across the board, almost 70 percent of cut points got higher, so many plans were surprised to find themselves earning lower ratings on the same or higher scores because so many cut points went up. Plans should note that continuous improvement is an imperative now. What got them to a higher rating in the past was not enough to keep them there.”
Therefore, Handshuh says, plans must understand the latest and best ways to work each measure from a strategic perspective and how to become nimble and adaptable. Handshuh says she and Smith will discuss organizational change management strategies during their session to help plans succeed at Star ratings.
“Plans should reach outside the bounds of their own organization to their providers and members to create a holistic partnership amongst the three parties,” she says. “That could mean educating members on how to be good consumers of health care, improving their health literacy, and then working with providers to take barriers out of the way to help them drive intended outcomes. Leaders should make sure those things work well together, for example, does the plan offer the right benefits and formulary for its population? Is customer service staffed with the right people? Are you keeping up with the way members want to receive information and communicate, because it's not the same as it was five years ago or even two years ago. Member preferences evolve and plans should evolve their strategy accordingly.”
Learn Stars math
Wallace’s presentations will include a preconference workshop with Hyperlift that focuses on Star math and strategy. He describes the workshop as a mix of foundational Stars math and advanced calculations. Discussion will include the health equity index and how to maximize the heavyweight quality improvement measures.
Review legal challenges
During the main conference, Wallace will speak at a session on legal challenges to Star ratings with Daniel Weaver, SVP Stars and quality, Zing Health. They’ll discuss the success that SCAN Health and Elevance Health had in 2024, which led to the Centers of Medicare & Medicaid Services (CMS) to recalculate all 2024 ratings. In the weeks since CMS announced the 2025 Medicare Advantage Star ratings, several insurers, including Humana, Centene, HMO Louisiana, and UnitedHealthcare have filed lawsuits over the calculations. “There’s no reason to think that more plans won’t sue…They’re not just suing because Stars is hard or doesn’t make sense. They’re suing for real, specific issues and the way the new regulations were rolled out.”
How to innovate and boost Star ratings
Wallace will also kick off the last day of the conference with a session that explores innovation capabilities and Star ratings. He’ll join Peet van Biljon, adjunct professor, Georgetown University, McCourt School of Public Policy, who is working on a Ph.D. project that examines government incentives to see if they change behavior within the private sector. He chose Star ratings as his case study and will present information on how health plans use innovation internally, how they operate and execute budget and staff, and how it correlates with actual Star performance.
“Some plans put guardrails on what they call innovation and that prevents them from being able to budget like they could for innovation,” he says, adding that van Biljon will present evidence that shows that innovation is absolutely necessary to be good in Stars. “There are a lot of ways plans can learn to innovate more effectively and we believe it correlates directly to their Stars performance.”
The 15th Annual RISE Star Ratings Master Class will take place Dec.9-10, with preconference workshops on December 8, at the Omni Scottsdale Resort & Spa at Montelucia. Click here to see the entire agenda, roster of speakers, and how to register.