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Overview
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Recently, CMS released the 2025 Stars year data, providing a comprehensive overview of performance across various healthcare measures. This analysis focuses specifically on HEDIS® measures (excluding SNP measures such as C06 and C07) and applies weighting to derive insights for PPO and HMO contracts with over 2,000 lives, as of October enrollment data from CMS reports.
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Key Points
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HEDIS Measures: The analysis targets non-SNP (Special Needs Plan) HEDIS measures. The exclusions include measures like C06 (Medication Review) and C07 (Pain Assessment), which are only relevant to SNP plans.
Note: Not all contracts offer SNPs, therefore those measures were excluded to enhance the accuracy of comparison across contracts.
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HEDIS Weighted Raw Score: The CMS Stars system assigns different weights to measures based on their importance. For example:
- Most measures carry a weight of 1.
- Specific measures like C10 (Diabetes Care – Blood Sugar Controlled), C11 (Controlling Blood Pressure), and C15 (Plan All-Cause Readmissions) carry a weight of 3, highlighting their greater importance in the Stars system.
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HEDIS Measure Count: Some contracts with smaller membership do not meet minimum thresholds to be measured against all HEDIS measures, in those cases the aggregate HEDIS score for the contract is based only on the measures that met the threshold criteria
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Data Sources
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CMS Stars Performance Data: Data for the analysis was taken directly from CMS's Part C & D Performance Data repository, which tracks Stars measures across contracts: https://www.cms.gov/medicare/health-drug-plans/part-c-d-performance-data
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Enrollment Filtering: Contracts were filtered based on having more than 2,000 lives, using the CMS Medicare Advantage/Part D Contract and Enrollment Data from October 2024: https://www.cms.gov/data-research/statistics-trends-and-reports/medicare-advantagepart-d-contract-and-enrollment-data/monthly-enrollment-contract
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Methodology
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Measure Selection: HEDIS measures were chosen based on relevance to non-SNP data, with a focus on contracts that have sufficient data for each measure, ensuring comprehensive coverage. Measures C06 and C07 were excluded.
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Weighting System: HEDIS measures were weighted based on their importance in the CMS Stars rating system. Most measures had a standard weight of 1, while crucial measures like diabetes care, blood pressure control, and readmission (C10, C11, C15) received a weight of 3 due to their significance in health outcomes.
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Contract Filtering: Only contracts with more than 2,000 enrolled lives were included in the analysis, narrowing the focus to larger Medicare Advantage organizations with significant member populations.
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Calculation of Weighted Averages:
- For each contract, the weighted average of the Star ratings was calculated using the Stars system and applying the respective weightings to each measure.
- HEDIS measures were the primary focus, and data was aggregated to reflect performance on PPO and HMO products.
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Hedis Measures: The primary measures sourced from HEDIS includes:
C01: Breast Cancer Screening (Weighted 1)
C02: Colorectal Cancer Screening (Weighted 1)
C08: Osteoporosis Management in Women who had a Fracture (Weighted 1)
C09: Diabetes Care – Eye Exam (Weighted 1)
C10: Diabetes Care – Blood Sugar Controlled (Weighted 3)
C11: Controlling High Blood Pressure (Weighted 3)
C14: Medication Reconciliation Post-Discharge (Weighted 1)
C15: Plan All-Cause Readmissions (Weighted 3)
C16: Statin Therapy for Patients with Cardiovascular Disease (Weighted 1)
C17: Transitions of Care (Weighted 1)
C18: Follow-up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (Weighted 1)
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