Upcoming 2018 Cutpoints

We’re looking forward to the new star ratings data on the 11^th. Ahead of that, we examined the cut points from the plan preview which Medicare posted on their website.  A large majority of the cutpoints increased in difficulty or remained about the same. There were three areas where things got harder: complaints and disenrollment, medication adherence, and certain HEDIS measures. Despite having a few measures where things became notably easier, the main story is 2018 cut points got much harder.

The graphs below show the 2017 to 2018 percent change in cutpoint. A red bar corresponds to a condition that got harder while a green bar represents a condition that became easier. The first graph shows only Part C conditions while the second graph shows both C and D.

Complaints and Disenrollment

The biggest changes were in the member experience/operations measures of member complaints and members choosing to leave the plan. The 4-star threshold for complaints fell from 0.54 in 2017 to 0.31 in 2018 while members choosing to leave the plan decreased from 17 to 13. A 42.6% and 25.5% decrease, respectively, meaning they became significantly more difficult.

Medication Adherence

All medication adherence categories (Hypertension, Diabetes, Cholesterol) increased 2-3 points for 2018, creating a three-year upward trend, moving thresholds for Hypertension, Diabetes, and Cholesterol from 79, 79, and 77 to 82, 81, and 80, respectively. This has been a long-term trend, and we have yet to see evidence as to where it will start to level off.

HEDIS ®

Within HEDIS measures, the triple weighted controlling blood pressure jumped this year. Despite this jump, it is creating a cycle spanning back 4 years. The 4-star threshold values for it were 63 in 2015, 75 in 2016, 64 in 2017, and 75 for 2018. This increase represents a 17% increase from its current value, but a 0% change from where it was in 2016. In addition, Breast cancer, PCR and COA MR jumped this year. These two also had a decline the previous year, but still have a long term upward trend. On a percentage basis, PCR also jumped, but this amy just reflect CMS’s rounding for the small range of values.

Other

Several other measures became harder such as “Care for older adults” and “Diabetes Care”, although weren’t as large as the ones noted above. Some got marginally easier such as physical and mental health improvement and A1C control. The biggest jump is Appeal Auto Forward which became 180% easier to obtain. Despite this drop in difficulty, this is reversing last year’s increase in difficulty.

Increases in cutpoints are going to make acheiving a high star rating much more difficult. Although there are some cutpoints which stayed nearly the same or decreased in difficulty, the large amount of increases have created less room for error. 

Baltimore Health Analytics offer Analytics tools and consulting. Our services range from clinical strategy, software development, analytics, and execution. We will meet you where you are, fill in wherever help is needed, and pivot to wherever the opportunity is greatest. Please check back when the new Stars rating are released around October 11.