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Closing the Value Gaps in Medicare Advantage Plans

- Pained & Inflamed
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For Medicare Advantage (MA) plans, the decline in star ratings from 4.37 in 2022 to 4.04 in 2024 comes as no surprise (CMS, 2023). The Centers for Medicare and Medicaid Services (CMS) continues to make four-star ratings and above a difficult achievement, given the financial limitations of awarding high ratings to a large percentage of plans. As cut points rise and star ratings fall, the next step for MA plan leaders is to identify low-hanging fruit where measure-level improvements can drive a significant increase in plan value.   

Some of the most effective strategies to boost star ratings lie in the realm of musculoskeletal (MSK) care. Almost three-fourths of older adults suffer from back and joint pain, and this number will only grow as the U.S. population continues to age (USBJI, 2018). The high prevalence rate of MSK conditions among older adults represents a great opportunity for MA plans—improving back and joint pain kickstarts a cascade of holistic improvements like greater mobility, lower healthcare utilization, and better quality of life. Despite the long list of MSK metrics to improve over time, there are six key measures MA plans can address right away to move the needle in the right direction.

Sitting near the bottom of all MA star ratings, the average Osteoporosis Management in Women Who Had a Fracture star rating decreased from 3.1 to 2.6, with 74 percent of MA plans scoring three stars or below (CMS, 2023). Even some of the top national plans struggled with this measure, with an average rating of just two stars. To help boost long-term care for members with osteoporosis, MA plans are turning to musculoskeletal (MSK) solutions like Vori Health for holistic care that prioritizes whole-person, non-operative care. Vori Health’s doctor-led care teams, which also include physical therapists, health coaches, and registered dietitians, provide evidence-based treatment that focuses on improving bone health and overall patient outcomes through appropriate medication administration, adoption of regular weight-bearing exercises, attention to nutrition, and total wellness care.

While the average Reducing the Risk of Falling star rating held steady over the past year, the plateau stands still at a startling 2.9 stars (CMS, 2023). Approximately 55 percent of plans hold three or fewer stars, highlighting the critical need for a proactive approach to MSK care that establishes healthy habits and promotes joint stability—especially in the hips and knees—for Medicare members. Falls are an underappreciated public health crisis: one in four older adults fall every year with 37 percent of those requiring medical treatment or activity restrictions (CDC, 2023). Hip fracture is one of the most devastating and potentially deadly consequences of a fall—one out of three individuals over the age of 50 who fracture their hip die within 12 months (Katsoulis, 2012) .

Identifying individuals at high risk of falling is an important step to preventing fractures and their life-threatening complications. Vori Health’s MSK program utilizes predictive analytics to find members who may be at a higher risk for falling due to a lack of appropriate care, then connects members with the right care team that gets to the true root of the problem and provides long-term relief with holistic care. With both virtual and in-person care options to choose from, Vori’s hybrid MSK care program offers safe and convenient care options for members who are at a greater risk for falls.   

Over the past two years, the average Getting Needed Care metric has dropped by 0.2 points to a 3.4-star rating, with 46 percent of plans at or below three stars (CMS, 2023). To help knock down barriers to care for Medicare members, such as mobility or transportation challenges, Vori Health offers telehealth visits with integrative, physician-led care teams from any phone, tablet, or computer. With data showing that older adults are the most likely age group to utilize telemedicine services, telehealth is an ideal modality to improve access to needed care for the Medicare population, especially members who live in rural areas (Lucas, 2022).  

Similar to the Getting Needed Care measure, the average star rating for Getting Appointments and Care Quickly decreased by 0.1 points to 3.5 (CMS, 2023). An estimated 47 percent of plans scored three stars or below, meaning more MA members are waiting longer to even get in the door to see their clinicians. At Vori Health, members can access the care they need right at their fingertips without the long wait times or referrals needed for traditional, in-person-only MSK care. Vori members can schedule an appointment and see a specialty care doctor within 48 hours to receive the care they need.

The average Rating of Health Care Quality for MA plans fell from 3.6 to 3.3 over the last two years, marked by 55 percent of plans now at three stars or below (CMS, 2023). This decline is, in part, due to low-value MSK care offerings in the conventional healthcare setting. Instead of higher volumes of care, what’s needed is a new approach to MSK health that evolves alongside the needs of the Medicare population. Vori Health’s solution not only improves access for older adults but also provides effective physician-led care that, as proven with Vori’s low back pain program, reduces surgery by 78 percent compared to traditional care while significantly improving MSK pain in 77 percent of patients (VI, 2023).

From 2022 to 2024, the average Rating of Health Plan star rating fell from 3.5 to 3.1 (CMS, 2023), with the top four national MA health plans all scoring three stars in this measure. Currently, 57 percent of plans have three stars or fewer, forecasting major downstream losses if corrective actions are not taken to elevate plan quality—specifically to improve outcomes at a lower cost for members. Vori Health can help improve MA plan star ratings through our Net Promoter Score of 87 and 85 percent treatment plan adherence rate, all while generating up to a four-fold return on investment for health plans.

 

Getting Ahead of the Health Equity Index

Looking forward, star ratings will continue to dig into health plan quality and provide more accountability for value and outcomes. Beginning this year, for example, health plans will be evaluated with a new measure, the Health Equity Index, to determine if members truly have equal access to high-quality care. There’s no doubt that virtual specialty care will play a foundational role in closing care gaps, especially for elderly populations with MSK pain for whom access to high-value care is a daily adversity. Ensuring your Medicare population has convenient access to high-quality care—especially MSK care—via telehealth is crucial to getting ahead of this index.

Want to learn more about how Vori Health can improve your plan’s star rating with hybrid, whole-person MSK care? Reach out to our team today.

REFERENCES

CMS, 2023: 2024 Medicare Advantage and Part D Star Ratings. Centers for Medicare and Medicaid Services. October 13, 2023. Accessed December 4, 2023.

USBJI, 2018: The Hidden Impact of Musculoskeletal Disorders on Americans. (2018). Bone and Joint Initiative USA

Lucas, 2022: Lucas JW and Villarroel MA. Telemedicine Use Among Adults: United States, 2021. NCHS data brief, no 445. Hyattsville, MD: National Center for Health Statistics. 2022.

VI, 2023: 2023 Validation Report. Validation Institute.

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