Maximize your plan’s potential for 2025 by fully utilizing the CMS Plan Preview process. This important phase allows Medicare Advantage plans to refine their data, focus on key performance metrics, and prepare for high Star Ratings. By carefully analyzing critical areas, addressing care gaps, and staying ahead of industry trends, you can position your plan to excel and stand out. The Plan Preview is more than just a review—it’s an opportunity to enhance your strategy, improve health insurance quality, and set a strong path for success in the coming year.
What is a Plan Preview?
Plan Preview is a helpful tool within the Health Insurance Oversight System that allows healthcare providers and states to review their plan details and ensure accurate information is displayed for consumers on Healthcare.gov. Think of it as a double-check to make sure everything about your plan is presented clearly and correctly.
How Does it Work?
Plan Preview is divided into two phases:
- Plan Preview 1 (Early to Mid-August): This is your first chance to review your plan details.
- Plan Preview 2 (Early to Mid-September): Here you can see any updates or corrections made after the first review.
The tool provides two key sections:
- Rating Scenario Page: See how your plan stacks up against others based on consumer ratings. You can even add dependents to see how the plan fits their needs.
- Plan Details Page: Once you choose a plan, you can view all the important information like benefits, deductibles, and other costs.
By using Plan Preview, you can ensure consumers have accurate and up-to-date information to make informed decisions about their healthcare plans.
Plan Preview 1
The initial phase of the plan preview, which took place from August 9-16, 2023, provides health insurance quality plans with an essential opportunity to examine the data they submitted to CMS. During this time, plans can conduct a comprehensive assessment of their performance metrics, ensuring data accuracy and identifying any inconsistencies.
CMS distributes memos highlighting critical data points that impact the 2024 Star Ratings, including insights from CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys. At this point, plans should prioritize validating all submitted information, evaluating each performance measure, and confirming adherence to HEDIS (Healthcare Effectiveness Data and Information Set), Medicare Advantage (Part C), and Prescription Drug Plans (Part D) reporting standards. Any identified errors or inaccuracies must be rectified before the second preview to facilitate timely adjustments.
Plan Preview 2
The second phase of the plan preview, (from September 8-15, 2023,) grants plans a vital final opportunity to evaluate critical performance data and calculate star ratings for the upcoming year. During this phase, plans receive comprehensive insights on final cut points, percentage achievements for specific measures, and overall performance scores for Part C and Part D. This process allows plans to conduct an in-depth analysis of their performance metrics, compare results against benchmarks, and assess how their strategies align with the star ratings system. Furthermore, this is the last chance to correct any discrepancies in data or performance issues before CMS finalizes the 2024 ratings, ensuring that all necessary updates are effectively applied.
This stage is essential, as the insights and adjustments made here directly impact a plan’s quality score. The goal is not only to enhance accuracy but also to strategically position plans for higher ratings and improved member satisfaction.
Understanding the Medicare Star Rating System
The Medicare Star Rating System, introduced by The Center for Medicare & Medicaid Services (CMS), enables beneficiaries to evaluate and choose Medicare advantage plans based on quality. Updated annually and scored from 1 to 5 stars, the ratings assess plan performance on factors like preventive care, wait times, and consumer complaints. The results are released in October, with both Medicare Advantage and Medicare Part D prescription drug plans undergoing this evaluation.
For individuals choosing a new plan or considering a switch, these ratings offer a straightforward quality guide.
Medicare Star Rating Levels
Plans are rated on a scale of 1 to 5 stars, though newer plans may have limited data:
- 5 Stars: Excellent
- 4 Stars: Above Average
- 3 Stars: Average
- 2 Stars: Below Average
- 1 Star: Poor
Plans with a rating of 3 stars or lower for three consecutive years are classified as “low performers.” Members in these plans receive a notification advising them to consider other options. Additionally, plans with a 5-star rating qualify for a special enrollment period, allowing members the opportunity to switch to these high-quality plans.
Key Takeaways for Plan Preview 2
The second phase of the Plan Preview is your final chance to review your plan's performance and make necessary adjustments before the 2024 star ratings are finalized. Here's a checklist to help you make the most of this important process:
- Analyze the Outlier Deletion Model: Understand its impact on cut points and identify significant changes.
- Investigate Increased Cut Points: Determine the reasons behind significant increases and assess their effects on performance.
- Stay Updated on Industry Trends: Monitor changes in healthcare quality and pinpoint improvement areas for your plan.
- Compare Your Ratings: Benchmark against industry standards to identify opportunities for enhancement.
- Gather Stakeholder Feedback: Seek input from providers, patients, and internal teams for a well-rounded perspective.
- Adjust Your Strategy: Refine your plan’s goals and strategies based on analysis insights.
- Set Clear Goals: Define specific, measurable objectives to boost your plan’s performance.
- Document Your Process: Maintain thorough records of your review process and any modifications made.
By following these steps, you can ensure your plan is well-positioned for success in 2024 and beyond.
Conclusion
The CMS Plan Preview process is crucial for Medicare plans aiming to enhance their performance in 2024. Actively participating in both phases allows plans to ensure data accuracy, identify and resolve care gaps, and adjust strategies based on industry trends and stakeholder input. This proactive approach not only improves care quality but also prepares your plan for higher star ratings, resulting in better member outcomes and increased satisfaction. By dedicating efforts to continuous improvement and strategic planning, your organization can successfully meet its objectives and excel in the changing healthcare environment.
