Navigating changes to the methodology for 2024 Star Ratings

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A doctor discussing exam results with a happy patient. Star ratings are like customer reviews: They rank Medicare plans on a 1-5 scale, impacting your reputation among eligible consumers. But the way you’re graded changes over time, unlike the many gadgets and gizmos rated across the web. See what’s different for 2024 Star Ratings and what it means for your plan.

Shifts in Star Rating methodology

The way Star Ratings are calculated will look different in 2024. Changes to the methodology not only make it harder to achieve five-star ratings, but also cut costs for the Centers for Medicare and Medicaid Services (CMS) by at least $2.3 billion. A major force behind all this? The Tukey outlier deletion, which could account for $935 million in savings in 2025 alone.

The primary changes in methodology for 2024 Star Ratings surround a few key areas:

Weight of quality measures

Star Ratings are based on the averages of 40 measures surrounding mortality, safety of care, readmission, patient experience and timely and effective care. But CMS often changes the weight of these measures — and 2024 wasn’t immune. All 40 measures are given Star Ratings based on cut points, or score ranges that fall within different star values. CMS removed the lower- and higher-range outliers from score averages in 2024, creating the Tukey outlier deletion.

The Tukey outlier deletion increases Star measure cut points — reducing scores for most measures. But some quality measures have become even more important. The most needy patients often suffer from comorbidities and are responsible for the bulk of health care costs in the U.S., so various measures are now triple-weighted to ensure plans focus on caring for those who need it most. Medication adherence is among these measures, as CMS views it as essential to preventing conditions from progressing. 

Health equity index

CMS is making a switch, removing the traditional reward factor that once helped boost plan Star Ratings anywhere from 0.1-0.4 stars higher. Beginning in 2028, this factor is being replaced by the health equity index, using data from 2024 and 2025 measurement years.

This change isn’t intended to penalize anyone, but rather to help underserved groups, including diverse races and cultures, the LGBTQ+ community and people living in remote areas without health care access. The better your plan can show that it helps low-income, dual-eligible and disabled members, the better it’s expected to perform with the health equity index in effect.

Additional changes

Of course, there are a few other pieces to keep tabs on as we move through this year. For one, the Tukey outlier deletion also reduces the number of contracts using the Hold Harmless provision, so fewer plans consistently rated 4.0+ stars are eligible to receive a higher overall Star Rating by CMS with and without improvement measures. Additionally, new contracts under existing parent organizations do not have a 2024 Star Rating. They’ll instead receive 2025 MA payments based on that organization’s weighted Star Rating.

Need a better way to reach Medicare members? Discover how the right member  engagement program can improve health outcomes.

Adapting to the changing landscape 

Exceptional Star Ratings are more difficult to earn than ever. However, achieving great ratings is possible when you focus on meeting members where they are, responding to their needs and shaping positive experiences.

Refocus on SDOH 

What do your members need? The most vulnerable are more likely to rate plans low, as health care engagement takes a backseat and they often misinterpret care-related interactions when they finally visit. 

Capture a baseline clinical profile of each patient by gathering relevant data — from chronic conditions and historical engagement to the risk of loneliness and social drivers of health (SDOH) needs. Use SDOH assessments to key in on members with greater needs and higher disengagement, who often face barriers to care and need care management assistance. Your plan can reach these populations and score a member’s risk of leaving, opening the door to providing the right communications and resources to address the gaps.

Want to know a few places to start meeting SDOH needs? Connect members with the right resources, such as food banks and meal delivery programs. But don’t be afraid to nudge them toward engaging with their health! Make it easy for members to adhere to health plans with appointment and medication refill reminders and referrals. 

Elevate the patient experience

Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores are still heavily weighted for 2024 Star Ratings, with member experiences prioritized over outcomes. You can improve CAHPS scores and Star Ratings by going the extra mile with:

  • Year-round programs: Focus on CAHPS year-round and provide value for members by improving member experience, information delivery and health equity/access.
  • Member service technology: Make it easy for members to get what they need. An AI bot can quickly direct members and reduce service queues, while email, chat and text options help members get in touch on their terms.  
  • Personalized communication: Use what you know about members to provide relevant information, from resources for chronic health conditions to preventative care. When messages go out, gauge how members interact to determine if you should change your approach.
  • Education on programs and resources: Health literacy can be a major barrier, so give members the tools to manage their health. Plug those knowledge gaps with helpful communications so members stay engaged and maintain positive perceptions.  
  • Improve experience holistically: Incorporate a peers-as-a-service program to reach out, engage and learn about the context and barriers members face in obtaining care.

Elevate your 2024 Star Ratings

Are you seeking a five-star rating for your Medicare plan in 2024? Elements such as the weight of quality measures and the health equity index will play new roles in your score potential, but you can earn your spot among the top Medicare plans. Just remember: It’s all about what your members need. 

Pyx Health is ready to help you navigate changes to 2024 Star Ratings. Our dedicated support staff — ANDYs — connect members to appropriate plans and community resources, while our app hones in on SDOH with evidence-based assessments for members and activities to improve engagement.

Could an engagement program be a step in the right direction to solve member needs and boost your Star Ratings? Explore our checklist for help choosing the right fit. 

Cover of Key Considerations for Choosing a Medicare Member Engagement Program