COVID-19's impact on Medicare Advantage star ratings still murky: experts

A finger pointing at stars
Medicare Advantage experts weighed-in on the pandemic's potential impact on star ratings during a Fierce Health Payer event this week. (Getty/Oko_SwanOmurphy)

The potential long-term impacts of COVID-19 on how Medicare Advantage's star ratings are calculated remain unclear, experts say.

Tom Kornfield, senior consultant at Avalere, said during Fierce Health Payer's Virtual Series on MA this week that due to changes around the data the Centers for Medicare & Medicaid Services is using to calculate the ratings under the pandemic, the industry could feel the ripple effects for sever years.

MA star ratings are generally calculated based on data that's two years old, and CMS has eased reporting requirements for this year. Kornfield said that future guidance is unclear on how 2020 data will be used, and how different that data could look due to COVID-19.

Medicare Advantage plans could be feeling the impacts as late as 2023 or 2024 on their star ratings, he said.

"There are some pieces that we know and some that we don’t know," Kornfield said.

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Under ordinary circumstances, however, what's the key to securing strong scores on the star ratings? Data and analytics, says Romilla Batra, M.D., chief medical officer at SCAN Health Plan.

California-based SCAN's membership is entirely in Medicare, and they offer a variety of special needs and supplemental coverage for seniors, including dual eligibles. Batra said that as the care needs are so different between members, having actionable data that's useful at both the population and individual levels is critical.

For example, SCAN has a diverse member population, so having data to identify which ones need services provided in languages other than English allows the insurer to more effectively meet the needs of those members, she said.

That said, the guidelines around star ratings are constantly evolving. Batra said SCAN puts a lot of effort into continuing to evolve alongside those changes.

"Our goal, our mantra at SCAN is to be the best at getting better," she said.