Welcome to the Stars Monitor user guide, your comprehensive resource for getting the most out of our platform. Whether you're a new user or looking to explore advanced features, this guide is designed to provide step-by-step instructions, tips, and best practices. Each article includes details on how to use the different screens in Stars Monitor.

Understanding what's on this page using example data:

1. Measures Underperforming 2022: This bar chart lists the top ten measures where the plan is currently underperforming compared to the same month last year. The measures are listed in descending order of underperformance, with 'Diabetes Care - Eye Exam' showing the most significant gap.

2. Additional Points Potential: The second chart indicates the additional points the plan could gain if it meets the Star rating goal for various measures. The measure 'Planned All Cause Readmissions' has the most significant potential to improve the overall score, suggesting focused efforts here could be particularly impactful.

3. Measures Underperforming 2022 by Measure Set: This pie chart aggregates the number of measures underperforming within each set (HEDIS, Ops, PDE) when comparing the current month to the same month in the prior year. The majority are within the HEDIS measure set, indicating this is a key area for improvement.

4. Additional Points Potential by Measure Set: This pie chart illustrates how many basis points could be added to the overall score if the goal ratings in each measure set were achieved. Most additional points could come from HEDIS, followed by Pharmacy and QI measures.

The "Current Month Alerts" section is crucial for plan management, as it highlights immediate areas of concern that may require targeted interventions to improve performance. The focus is on identifying specific measures where the plan can improve and quantifying the potential impact of these improvements on the overall Star Rating. This enables the plan administrators to prioritize actions and allocate resources effectively to improve the plan's CMS Star Ratings.

Understanding what's on this page using example data:

1. Contract ID H3333: This identifies the specific Medicare Advantage plan being evaluated.

2. Stars 2025 Performance Scorecard: The data is aimed at projecting the performance scorecard for the year 2025.

3. Overall Score - Projected: The plan’s projected overall score is 4.08, with a lower and upper range of 3.85 and 4.53, respectively.

4. Goal: The plan's goal is to achieve an overall score of 4.55.

5. Goal Variance: The plan is currently -0.47 points below the goal.

6. Goal Variance Drivers: It breaks down the variance from the goal into specific categories: CAHPS, HEDIS, HOS, Ops, and Pharmacy, indicating where the plan is falling short or exceeding expectations.

7. Star Rating Components: This gives a detailed view of projected scores versus goals for various aspects of the plan's performance, including:

   • Final Overall Rating

   • Part C Score

   • Part D Score

   • Ratings for quality improvement (QI) for both Part C and Part D

   • Reward Factor

   • CAI Value (Categorical Adjustment Index)

8. Measure Set Projected vs. Goal Performance: This section compares the projected performance versus the goal for different sets of quality measures (CAHPS, HEDIS, HOS, Ops, Pharmacy).

9. Included Data As Of: It indicates that the current data includes information up to November for HEDIS, Operations, and Pharmacy measures, suggesting that these are the latest months for which data is available to inform the projections.

The Executive Summary is useful for plan administrators and stakeholders to assess the performance of the Medicare Advantage plan at a high level. The aim is to identify areas needing improvement and to understand the impact of various factors on the plan's overall quality rating. The information is strategic for quality improvement efforts and may influence consumer choice, as higher-rated plans are often more attractive to beneficiaries.

Understanding what's on this page using example data:

1. Projected vs. Targeted Performance:

   • This section compares the projected performance score to the targeted performance score for each contract. H1111 is projected to score 4.66 but is targeting a higher score of 4.95. H2222 has a lower projected score of 3.55 and is targeting 4.25.

2. Percent of MAPD Enrollment:

   • Indicates the percentage of Medicare Advantage Prescription Drug (MAPD) enrollment for each plan, with H1111 having 86% and H2222 having 14%.

3. Stars 2025 Projected and Targeted Scores:

   • Displays the specific Star Ratings that each plan is projected to achieve and their targeted goals. H1111 is close to its target, with a variance of -0.29, while H2222 is further away, with a variance of -0.7.

4. QI Measure Ratings Part C and Part D:

   • Shows the Quality Improvement ratings for Part C and D. H1111 has achieved the highest rating of 5 for both, while H2222 is at 3 for Part C and 4 for Part D.

5. Projected Reward Factor:

   • H1111 has a projected Reward Factor of 0.40, which can add bonus points to the overall score, while H2222 has no projected Reward Factor bonus points.

6. Projected Quality Improvement (QI) Measure Ratings:

   • A bar chart displays the QI ratings for both contracts, emphasizing the strength of H1111 in both Part C and D.

7. Projected Percent of Members in <4 and 4+ Contracts:

   • A pie chart illustrates the percentage of members in contracts rated below 4 stars (13.6%) and those in contracts rated 4 stars and above (86.4%).

This screen is particularly useful for plan administrators or stakeholders who manage multiple contracts, as it provides a quick comparative snapshot of how each plan is performing relative to its goals and to each other. The visual format allows for an easy understanding of where each plan stands in terms of achieving quality targets, which can guide strategic decisions and resource allocation for improvement efforts.

Understanding what's on this page using example data:

1. HEDIS (Healthcare Effectiveness Data and Information Set):

   • It shows a negative variance of -0.07, meaning these clinical quality measures are performing below the goal.

   • Specific measures under HEDIS that are driving this negative variance are listed, like Planned All Cause Readmissions, Diabetes Care - Eye Exam, and others.

2. Pharmacy:

   • Indicates a positive variance of 0.02, suggesting better performance in pharmacy-related measures like Statin Use with Diabetes and Med Adh for Hypertension.

3. Operations:

   • A negative variance of -0.11 points, with several operational measures listed that affect this score, such as Plan Makes Timely Decs - Appeals, Reviewing Appeals Decisions, and Complaints about the Health Plan.

4. CAHPS (Consumer Assessment of Healthcare Providers and Systems):

   • No variance indicated (0.00), suggesting that performance on these measures matches the goals. CAHPS are survey measures, so it's not uncommon to see a 0.00 delta from target indicated for this measure set.

5. HOS (Health Outcomes Survey):

   • A small negative variance of -0.02, with Monitoring Physical Activity being a specific measure mentioned. HOS

6. QI Measures (Part C & D):

   • Shows a negative variance of -0.05, indicating areas like Monitoring Physical Activity and Diabetes Care - Eye Exam need improvement.

7. Reward Factor:

   • Displays a negative variance of -0.20, which is quite significant. Measures like Med Adh for Cholesterol and Statin Therapy-Patients with CVD (Cardiovascular Disease) are contributing to this variance.

8. Overall Stars 2025 Score Details:

   • Reiterates the projected overall score of 4.08, the goal of 4.55, and the variance from the goal of -0.47.

   • The current month for data consideration is November.

9. Bottom Navigation:

   • This section provides quick navigation buttons to go to specific areas like HEDIS, Pharmacy, Operations, CAHPS, and HOS for more detailed analysis.

This screen is valuable for identifying specific areas where the Medicare Advantage plan is underperforming or overperforming compared to its goals. It can help in targeting improvement initiatives to areas that will have the most significant impact on the overall Star Rating.

Understanding what's on this page using example data:

1. Historical Current Month Scores: This section shows the performance of the plan on Breast Cancer Screening over the past four years (2020-2023), with scores appearing to improve slightly year over year.

2. Projected QI Category: The plan is projected to achieve "Significant Improvement" in the Breast Cancer Screening measure.

3. Gaps Closed from This Month to Year-End Prior Year: Indicates the number of gaps closed from the current month to the year-end of the prior year, with a figure of 3,118.

4. Gaps Required to Close to Reach Target: Shows the number of gaps that need to be closed to meet the target, with a figure of 2,963.

5. Historical Monthly Performance: A bar chart displays monthly performance over several years, juxtaposed against a target glide path based on the previous year's trend. The goal is to visualize the plan's performance relative to the target and the trajectory needed to achieve future goals.

6. Historical Year-End Scores: Provides a summary of year-end scores for Breast Cancer Screening from 2020 to 2023, showing a steady increase over time.

7. QI Measure Threshold Proximity:

   • Significant Decline: The score is safely above the lower threshold that would indicate a significant decline.

   • Projected: The current projected score.

   • Significant Improvement: The projected score score is above the threshold for significant improvement.

8. Cut Point Proximity:

   • Lower CP (Cut Point): The score is above the lower cut point.

   • Projected Score: The current projected score.

   • Upper CP (Cut Point): The score is below the upper cut point, indicating room for improvement to reach the next level.

This screen is important for plan administrators as it provides a detailed view of a single measure's performance, which is crucial for targeted interventions. The visualization of the data allows for an easy understanding of trends and proximity to various thresholds, enabling strategic planning to improve scores and ultimately the plan's overall CMS Star Rating.

Understanding what's on this page using example data:

1. Projected QI Ratings: Both Part C QI and Part D QI are projected to have a rating of 5, on a scale of 1 to 5, where 5 represents the highest QI Rating possible.

2. Measure Set: A list of specific quality measures is shown, indicating whether each measure is "Behind" or "On Track to Achieve QI Significant Improvement." Most measures are marked as "Behind," implying that the plan needs to make improvements to meet its QI targets.

3. Bar Chart (Breast Cancer Screening): This chart illustrates the historical monthly performance for the 'Breast Cancer Screening' measure. It compares actual performance across three years (2021, 2022, 2023) against a glide path – a projected target line based on the 2022 trend. The bar chart shows that while performance has been improving year over year, it is still behind the glide path needed to achieve significant improvement.

4. Key Metrics for Breast Cancer Screening:

   • Planned Target: The target score for this measure is 77.0.

   • Stars 2024: The actual score achieved in 2024 was 76.8.

   • Projected Year-End: The projected score by the end of the current year is 79.0.

   • Sig. Improvement: The score needed for significant improvement is 77.2.

The screen is designed to help plan administrators understand the current status of their quality measures, how they have been trending over time, and what targets need to be met for significant quality improvement. This kind of analysis is critical for ensuring that the health plan meets CMS Star Ratings criteria and for implementing timely interventions where needed to improve the plan's overall performance.

How to use the Scenario Modeler:

Stars 2025 Performance Scorecard - Scenario Modeler

Scenario Modeler Tool User Guide:

Overview

The Scenario Modeler Tool enables users to simulate the impact of different performance measures on their overall Medicare Star Ratings score. By adjusting projected scores, users can assess potential outcomes and strategize for improvement.

Getting Started

1. Access Scenario Modeler: Log into your dashboard and navigate to the Scenario Modeler section.

2. Select a Contract: From the drop-down menu, choose the contract you wish to model scenarios for.

Editing Projections

1. Adjust Measure Projections: Locate the blue cells corresponding to each measure. These are editable fields where you can input new projection scores.

2. Enter Scores: Click on a blue cell and type in your new projected score for that measure. Press Enter or click outside the cell to save the entry.

Reviewing Impact

1. Automatic Recalculation: The model will automatically recalculate your overall Star Ratings based on the new projections you've entered.

2. Cut Point Forecast Proximity: Examine how close your new projections are to the next cut point that could affect your Star Rating.

3. Additional Points: Understand any additional bonus points you could earn for reaching the next Star level for each measure.

Analyzing Outcomes

1. Model vs. Target: Compare your model's projected scores against target scores to identify gaps.

2. Improvement Goal: Set an overall improvement goal for your Star Rating and see how your new projections affect the remaining gap.

3. Reward Factor Analysis: Evaluate how the new projections impact your Reward Factor and overall rating.

Scenario Management

1. Save Scenarios: You can save different scenarios for future reference or comparison.

2. Load Scenarios: To review or further edit a saved scenario, simply load it from your saved list.

Tips for Effective Scenario Modeling

• Experiment with different combinations of projected scores to see which measures have the most significant impact on your overall rating.

• Focus on measures where small improvements can lead to substantial gains in star ratings.

• Pay attention to the "QI Eligible" column to prioritize measures that qualify for Quality Improvement efforts.

Remember, the goal of the Scenario Modeler is to enable strategic planning by visualizing how changes in performance measures can influence overall Medicare Star Ratings. Use this tool as part of your broader quality improvement initiatives to maximize your plan's potential.

For detailed instructions and support, refer to the Help section or contact the support team directly through the platform.

Understanding what's on this page using example data:

1. Reward Factor Improvement Opportunities: This bar graph shows measures that are projected to negatively impact the Reward Factor calculation. The measures are displayed along with their distance from the upper forecasted cut point, indicating how far they are from meeting a higher standard. 'Annual Flu Vaccine' and 'Osteo Mgmt in Women W Fracture' are the furthest behind.

2. QI Upside Opportunities: This bar graph identifies measures that are close to achieving the next positive QI threshold. These are areas where the plan is nearly meeting its targets and where slight improvements could lead to a positive shift in QI. 'Osteo Mgmt in Women W Fracture' and 'Annual Flu Vaccine' have the highest potential for positive change.

3. QI Risk Points: This bar graph shows the measures that are at risk of dropping to a lower QI category. It highlights areas where there is a need for immediate attention to prevent a decline in QI scores. 'Rating of Health Care Quality' and 'Med Adh for Cholesterol' are most at risk.

Each bar graph serves as a strategic tool for the health plan to prioritize areas for improvement. The screen aims to help plan managers understand which measures can have the most substantial impact on the plan's overall performance and where to focus efforts for quality improvement or risk mitigation. The goal is to optimize the plan's overall score by enhancing areas with the most significant potential for positive change and addressing those at risk of declining.

Target Refinement Sessions

Overview: The Target Refinement Sessions page is designed to assist with setting and refining targets for Stars 2026, particularly focusing on the Breast Cancer Screening measure. It features a comprehensive set of tools that allow users to view historical data, set future targets, and understand how these targets compare to national averages and top performer thresholds.

Editable Targets:

• Planned: The baseline goal set for the Stars 2026 year.

• Stretch: An aspirational goal that aims higher than the planned target.

Sections of the Performance Scorecard:

1. Stars 2026 Targets:

   • View and edit the Planned and Stretch targets for the Breast Cancer Screening measure.

   • Observe the impact on the score and ratings when targets are edited.

   • "Movement-Based Targets" are realistic targets based on what similar plans have been able to achieve year over year. The "Average" is the average positive movement for similar plans were able to achieve year over year. The "Top 30%" is focused on the highest-performing similar contracts and their documented performance improvement year-over-year.

2. National Average:

   • Compare past years' national averages for the measure to assess historical performance.

3. Historical (and Planned Target) Measure Scores by Stars Year:

   • View the historical measure scores and ratings from Stars 2022 to Stars 2025.

   • Projected ratings for Stars 2026 are displayed based on the Targeted Score and Rating.

4. Stars 2026 Projected QI Sig Imp Threshold:

   • Indicates the Quality Improvement Significant Impact Threshold for Stars 2026.

5. Overall Planned Target Results:

   • Summarizes the overall target ratings based on the Planned and Stretch goals.

6. Planned Target Relation to Upper and Lower Fcstd Cut Points:

   • Visual representation of where the Planned targets sit relative to forecasted lower and upper cut points, which dictate star ratings.

7. Cut Point History:

   • Provides a historical view of the cut points for different star ratings over the years, including the application of Tukey outlier deletion and expected cut points for future years.

Editing Targets and Viewing Updated Calculations:

• To edit the Planned or Stretch targets for Stars 2026, click on the "EDIT" button next to the targets. After you make the edits and are ready to save, hit the "COMMIT CHANGES" button.

• As you edit the targets, the system will automatically update the score calculations and visualize how these changes affect the overall performance.

Remember, all changes made to targets should be saved and confirmed. It's recommended to consult with your team or management before finalizing new targets, as these will influence strategic planning and operations.

Basis points: a single basis point amounts to a decimal value of 1 in the hundredths place (0.01). In the context of Stars, basis points can be referred to as components of measure level rate performance (on a scale of 0 to 100% for most measures) or as components of summary ratings (on a scale of 1 to 5).

· Measure level rate: A rate increase of 50% to 65% corresponds to an increase of 15 basis points.

· Summary rating: A rating increase of 3.72 to 3.79 corresponds to an increase of 7 basis points.

Measure Set: sometimes referred to as measure categories, measure sets are groupings of measures based on data source. Stars Monitor uses the following measure sets (as of the 2025 Rating Year): HEDIS, CAHPS, HOS, ADMIN, PDE, QI. For the full list of measures and corresponding measure set, see Appendix.

Projected performance: Hyperlift projects end-of-year performance for the current measurement year. The projection is based on the current rate and a predicted completion factor (rate change by end of year). The completion factor is determined by historical performance trends. The more historical data plans can provide, the more accurate the completion factor will be. Projected performance at the measure level is aggregated into projected summary ratings (Measure Set, Part C Summary, Part D Summary, Overall Rating).

Target performance: These are targets set by the plan at the measure level. Target performance at the measure level is aggregated to produce target summary ratings (Measure Set, Part C Summary, Part D Summary, Overall Rating).

Variance from target: Depending on the level of aggregation being viewed (Measure, Measure Set, Part C Summary, Part D Summary, Overall Rating), the variance from target refers to the projected performance minus the target performance. Variance can be positive or negative. For example:

Variance Sources: When viewing summary level performance, Stars Monitor frequently includes “Variance from target” as well as drivers of variance or variance sources. These are displayed at the measure set or measure level depending on the view. Variance sources are quantified based on the number of basis points attributable to the measure set or measure that is tracking above or below target. These drivers are only captured when measure level rate variance results in a material impact to measure level star. Basis points attributed to variance sources are determined by measure level star variance and measure weight.

Reward Factor and QI Optimization: The Star Monitor platform is intended to optimize performance on the 5x weighted improvement measures and maximize positive impact of the reward factor. Individual measures are specified as opportunities to improve performance minimally in order to have a much broader impact on overall performance through reward factor and QI.

Year-End Projection Analysis for the Stars 2025 Performance Scorecard. This functionality enables users to analyze and adjust their year-end score projections for specific measures within their Medicare Advantage plan. Here's a guide on how to use this screen effectively:

1. Projected Score Range: You can view and edit your expected year-end scores, providing a lower and upper estimate range to gauge performance variability.

2. Measure Performance Overview: This section lists historical scores and projections for individual measures, allowing for a year-over-year comparison to assess trends and improvements.

3. Adjusting Projections: If your current measures are tracking differently than expected, you can edit the projections to simulate how these changes may affect your year-end scores.

4. Trend Analysis: The bottom graph displays monthly performance trends across the current year, offering visual insights into the trajectory of your measures.

5. Projection Comparison: The screen compares your projected scores against a target, set as a performance goal, allowing you to determine the gap between current projections and desired outcomes.

6. Saving Projections: After adjustments, you can save the new projections, facilitating scenario planning and helping to inform strategy for performance improvement.

This tool is critical for Medicare Advantage plans looking to optimize their Stars Scores by making data-driven decisions. By understanding historical performance and adjusting for current trends, plans can set realistic targets and implement necessary interventions to improve their ratings.

1. Stars 2025 Projected Reward Factor:

   • The current projected reward factor bonus points are 0.00, indicating that, as of now, no additional bonus points are projected to be added to the plan's overall score due to the Reward Factor.

   • "QI Applied?" is marked as "Yes," indicating that Quality Improvement measures are considered in the calculation.

2. Contract Mean and Variance:

   • The contract's mean score is 3.41, which falls into the "Too Low" category, indicating that the plan's average performance is below a satisfactory level.

   • The variance score is 1.46, categorized as "High," implying that there is significant variability in the plan's performance scores.

3. Distance to Next Category:

   • Shows the numerical gap that needs to be bridged to improve the contract's mean and variance to the next category, which are 0.34 and 0.13 points away, respectively.

4. Next Category:

   • The categories the plan would move into if it bridges the gap in mean and variance scores. For mean, the next category is "Relatively High," and for variance, it is "Medium."

5. Mean Optimization:

   • This section explains that improving the mean to "Relatively High" or "High" will impact the Reward Factor. It shows the projected rating for certain measures, the distance to the upper forecasted cut point, and the additional points these measures could contribute to the overall score if the next Star rating is reached.

6. Variance Optimization:

   • Highlights that improving variance to "Medium" or "Low" will benefit the Reward Factor bonus. It notes that a higher variance factor worsens the Reward Factor bonus and that improving a measure's Star rating does not necessarily improve the variance.

7. Tables for Mean and Variance Optimization:

   • Display specific measures along with their projected ratings and, for variance, the variance factors. These tables help to identify where targeted efforts might yield improvements in the Reward Factor.

The screen is instrumental for plan managers to identify where to direct quality improvement efforts. It not only provides a snapshot of current performance against targeted goals but also guides which areas have the most potential for positively impacting the plan's overall Star Rating through the Reward Factor.

Understanding what's on this page using example data:

1. Stars 2025 Projected Reward Factor:

   • Shows that the projected Reward Factor bonus points are currently at 0.00.

   • Indicates that Quality Improvement (QI) has been applied.

2. Contract Mean and Variance:

   • The contract's mean score is 3.41, categorized as too low.

   • The variance score is 1.46, categorized as high.

3. Distance to Next Category:

   • Indicates the distance the contract must move to reach the next category for mean and variance, which are 0.34 and 0.13 points away, respectively.

4. Next Category:

   • If the contract improves, the next categories would be "Relatively High" for the mean and "Medium" for variance.

5. Reward Factor Overview:

   • Explains that the Reward Factor is an essential component that can improve Star Ratings by adding 10 to 40 extra basis points to the overall score.

   • The calculation is based on two components: Mean and Variance, and certain thresholds must be met to earn the bonus points.

6. Reward Factor Thresholds Used in This Model:

   • Provides the variance and mean thresholds used in the model, with and without QI applied.

   • It also mentions that the model typically uses the most challenging thresholds provided by CMS from previous years.

7. How is the Reward Factor Bonus Calculated:

   • Describes how each contract will be in one of three categories for Mean and Variance to be eligible for the bonus.

   • The contract must achieve at least "Relatively High" for Mean and "Medium" for Variance.

8. Bonus Calculation:

   • Illustrates the bonus points that can be earned based on the Mean and Variance categories.

This screen helps plan administrators understand the significance of the Reward Factor in improving their overall Star Rating and what specific targets need to be hit to gain additional points. It also shows the potential for improvement and where efforts might be most effectively applied. The screen provides actionable data that can guide strategies to enhance the plan's CMS Star Ratings.