Improving Star Ratings through Value-Based Kidney CareAuthor : Resham Puri, Associate, Strategy & Development
Star ratings an increasing driver of plan choice
With Medicare Advantage (MA) beneficiary turnover reaching a historical high of 16% for the 2023 plan year, it’s evident that Medicare beneficiaries are increasingly active consumers. While historically price has been a key driver of plan choice, zero premium plans have recently become a commodity and as a result, Star ratings are playing an increasingly important role in plan selection.
As seen in a 2018 study by Navigant, a 1-star improvement in rating can result in an 8-12% increase in plan enrollment. Compounding the market share impact, “improving from a 3-star to a 4-star rating can lead to a 13.4-17.6% increase in revenue through this increased enrollment as well as additional bonus payments.” As 17% fewer plans have a 4+ star rating in 2023 compared to the previous year (primarily due to the reversal of COVID era flexibilities), many plans are focusing even more on improving ratings to increase enrollment and improve financial performance.
Optimizing kidney disease management can impact multiple HEDIS measures and ultimately Star ratings
While historically chronic conditions such as diabetes and hypertension have been a key area of focus for improving HEDIS measure performance, and by extension Star ratings, plans are increasingly turning their focus to kidney disease. Kidney disease has a significant impact on measures related to utilization and chronic conditions and plays a significant role in positively impacting Star ratings.
As of 2017, 15% of the population over 65 had kidney disease with prevalence expected to increase. This population has high utilization, with a 30-day readmission rate for beneficiaries with chronic kidney disease (CKD) of 22%, and an annual hospitalization rate of 55%. Patients with CKD also tend to be highly comorbid, with only 4% of the CKD population not having any comorbidities. Based on a study conducted by BMC Nephrology in 2015, 88% of CKD patients have hypertension, 23% have ischemic heart disease and 17% have diabetes. Proper identification and management of high-risk/high-cost kidney disease patients can result in higher HEDIS scores for measures not only directly related to kidney disease but also those related to common comorbidities.
Value-based kidney care management essential to improve kidney disease outcomes and related HEDIS measures
Providing comprehensive care to patients with CKD and end-stage kidney disease (ESKD) in coordination with PCPs is essential in having a downstream positive impact on related HEDIS measures. These patients typically have upwards of five comorbidities and require intensive ongoing care management support in addition to kidney-specialized clinical interventions to manage their conditions. When patients receive the necessary care to treat both CKD and various comorbidities, they experience quality of life improvements directly related to HEDIS measures (e.g., more healthy days at home, fewer side effects from chronic illnesses). Strive currently manages care for many MA beneficiaries and deploys multiple clinical interventions that impact HEDIS measures utilized to calculate overall Stars performance. Strive utilizes a kidney-specialized, NP-led care anytime, anywhere model that includes in-home and virtual visits in order to complete workflows with high levels of patient impact. The following are a few examples of these workflows:
- Transitions of Care Management (TCM) focuses on engaging members in high-intensity care management following a hospitalization. This generally includes several steps managed by the Strive Kidney Heroes™ team including comprehensive medication management review, ensuring frequent follow-up appointments, and educating patients on necessary changes to their care plan. Examples of HEDIS measures Strive impacts include: Transitions of Care – Patient Engagement after Inpatient Discharge, Transitions of Care – Medication Reconciliation and Plan All Cause Readmissions.
- Co-Morbidity Management is a program led by nurse practitioners (NPs) to manage hypertension, diabetes and congestive heart failure through medication optimization, risk factor reduction and care coordination. These programs differ from standard diabetes, congestive heart failure and hypertension practices and instead incorporate elements that are specific to kidney disease. For example, our kidney-specialized NPs/dieticians will help a patient build a diet that is friendly towards both kidney disease and diabetes, and specialized pharmacists will focus on utilizing medication that is effective for both conditions but not nephrotoxic. Examples of HEDIS measures Strive impacts include: Controlling High Blood Pressure, Hemoglobin A1c Control for Patients With Diabetes and Kidney Health Evaluation for Patients with Diabetes.
- Medication Reconciliation Post-Discharge involves an in-person or telehealth review conducted upon enrollment and in ongoing visits with Kidney Heroes™ to prioritize medication-related problems and possible nephrotoxicity so that any issues can be resolved with the patient’s healthcare team. Examples of HEDIS measures Strive impacts include: Care for Older Adult – Medication Review, Statin Therapy for Patients with Cardiovascular Disease and Statin Use in Persons with Diabetes
Strive programs impact nearly 20 HEDIS measures, and our strong patient satisfaction results support plan performance on the CAHPS survey. The quarterly surveys we conduct with enrolled members have a strong alignment with the CAHPS survey, with a focus on timely access to care, clarity of communications, staff quality and care coordination. Strive also emphasizes putting the patient first by making the management of CKD and ESKD as simple and accessible as possible.
Results linked to a few of the HEDIS measures impacted by Strive include:
- 81% of patients complete a depression screening
- 80% of patients’ blood sugar is controlled
- 93% of patients’ blood pressure is controlled
- 55% decrease in hospital admissions per thousand for MA patients
Strive helps MA organizations navigate CKD and ESKD member quality and costs
Strive Health partners with leading MA plans and medical groups to offer kidney disease care services that improve member health outcomes and generate savings on total cost of care. To learn more about specialized planning and management of your CKD and ESKD patient populations, connect with us here.