Most Blues plans underperformed in the Medicare Advantage (MA) and Part D star quality ratings for 2018, struggling in particular with certain clinical measures and the health plan rating measure, according to CMS data.
Only 37% of Blues’ MA plan contracts received 4 stars and above, the level that makes plans eligible for quality bonus payments. Overall, about 44% of MA and MA prescription drug (MA-PD) contracts earned 4 stars or higher for their 2018 ranking.
“Most of the Blues have not done as well [as other MA plans] on star ratings,” says Alexis Levy, director at consulting firm HealthScape Advisors. That may be because many Blues plans tend to feature large PPO networks that are not as well-aligned with the insurer, making it more difficult for the plans to perform well on clinical measures, Levy tells AIS Health.
Levy notes that the number of Blues plans with 3-star contracts fell from 17 in 2017 to 12 in 2018. Of those plans that had 3 stars in 2017, nine remained at 3 stars, two improved to 3.5 stars and only one improved to 4 stars. “Four are no longer in the market, which I see as an indicator that plans that cannot achieve 4 stars will have a tough time remaining competitive in MA,” Levy says.
However, performance year over year remained steady, with about 37% of Blues MA plans earning 4 stars or higher for 2018, about the same as for 2017, Levy says. There are 81 Blues MA and MA-PD contracts, six fewer than in 2017, according to a HealthScape analysis.
Two Blues MA contracts earned 5 stars for 2018: Blue Cross and Blue Shield of Minnesota, which covers all 87 counties in the state, earned 5 stars for its Platinum Blue Cost plan, and Anthem Health Plans of New Hampshire, Inc. earned 5 stars for its Anthem MediBlue Access PPO, which covers 41 out of 159 counties in Georgia, 46 out of 120 counties in Kentucky, and five out of 10 counties in New Hampshire.
It’s noteworthy that the Minnesota Blues plan — with 250,000 members — was able to earn 5 stars, since it’s such a large plan that doesn’t have “direct control of physicians,” Melissa Smith, vice president, stars and quality innovations, Gorman Health Group LLC, tells AIS Health.
The Minnesota Blues plan says it established an internal Medicare Stars Center of Excellence in 2015 to drive improvement in the company’s ratings, by focusing on provider and member engagement, health improvement programs, administrative systems and data analytics.
An additional nine Blue-sponsored plans earned 4.5 stars, and 20 earned 4 stars, according to the HealthScape analysis. Only one Blues MA plan — an HMO sponsored by Blue Cross and Blue Shield of Texas — had 2.5 stars, and no Blues plans had 2 stars or fewer.
Anthem, Inc. performed well in the 2018 rankings: more than 60% of its membership will be in 4 star or higher plans, Anthem CEO Joseph Swedish said Oct. 25 in the insurer’s third-quarter earnings call. That’s “a meaningful increase from the 22% we had in 2016,” Swedish said.
Anthem “is the big winner this year,” says Smith. “They have been very public that it has been a focus, and they’ve made multi-year investments” in programs designed to improve their MA plan quality.
Star ratings “are critical to success in MA for Anthem,” Levy adds. “If you don’t have that 4-star and 5-star revenue advantage, you just can’t compete.”
To that end, Anthem agreed Sept. 20 to acquire HealthSun Health Plans, Inc., which serves about 40,000 members through MA plans in Miami-Dade and Broward counties and offers MA plans integrated with a care delivery system (HPW 9/25/17, p. 8). HealthSun’s plans received 5 stars for 2018.
Mass. Blues Plan Drops One-Half Star
Blue Cross Blue Shield of Massachusetts, which had earned 5 stars last year for its MA HMO plan, lost that rating for 2018. However, the plan dropped only half a star to 4.5 stars, and the insurer’s Blue MedicareRx Prescription Drug Plans (in partnership with Anthem and Blues plans in Rhode Island and Vermont) received 5 stars for the second year in a row, making it the top PDP plan in New England, the insurer said.
MA measures that gave Blues plans the most trouble included Reducing the Risk of Falling, Osteoporosis Management in Women who had a Fracture, Improving or Maintaining Physical Health, and Monitoring Physical Activity.
Blues plans averaged under 2 stars on the osteoporosis measure, which is “really significantly below the market,” says Smith. Their scores on fall risk also fell below the overall average, she says.
Clinical measures “are a lot harder to control,” Levy says. “If you look at where plans generally had trouble, that’s consistent.”
Blues Plans Aren’t ‘Flashy’
Overall, Blues plans score below the 3.4 average on Rating of Health Plan, Smith notes. This could be because “Blues plans do not have a reputation of being flashy or splashy — they’re stable, reliable and consistent.” Other insurers also may try to influence members more in an effort to produce higher scores, she says.
Blues plans did perform well on Part D measures, and three out of the seven PDPs receiving the coveted high performance icon were Blues-sponsored: the PDP sponsored by Anthem with Massachusetts, Rhode Island and Vermont Blues plans in central New England; Excellus Health Plan, Inc.’s PDP in New York; and the Upper Midwest PDP operated by Wellmark and Blues plans in Minnesota, Montana, Nebraska, North Dakota and Wyoming.
“Part D measures are more in the plan’s control — you’re not working with providers for improved clinical performance,” Levy says. This means Blues plans have a chance to perform better on them, and they tend to do so, she says.