My FTI colleagues Mark Van Ert and Krunal Patel summarize among the new high quality measures that will likely be included within the 2025 CMS Star Scores used to judge Medicare Benefit (MA) plans. The CMS Star Scores are crucial as a result of CMS funds to MA plans are anticipated to extend 3.7% or $16 billion between 2024 and 2025.

Van Ert and Patel describe the CMS ranking cycle as follows:

Star scores are decided via a four-year course of. The primary 12 months is the Measurement Yr (“MY”), throughout which plans accumulate efficiency information for varied measures, though the particular timing could range – for instance, Shopper Score of Healthcare Suppliers and Methods (“CAHPS”) surveys are carried out at first. of the second 12 months. In the course of the second 12 months – the reporting 12 months (“RY”) – the CMS evaluates the efficiency information from the earlier 12 months. The third 12 months is the Star Yr (“SY”), throughout which the Star Scores are formally awarded. Within the fourth 12 months — the 12 months of the standard bonus fee (“QBP”).⁴

What are the brand new measures for 2025? These embody:

• Concomitant use of opioids and benzodiazepines. Evaluates co-prescribing of opioids and benzodiazepines, which considerably will increase the danger of respiratory despair and deadly overdoses
• Use of a number of anticholinergic medicines in older adults. Measure addresses the dangers related to the concurrent use of a number of anticholinergic medicines in older adults, which can result in cognitive decline.
• Kidney well being for sufferers with diabetes. Measures the share of members ages 18-85 with diabetes (kind 1 and kind 2) who’ve undergone a kidney well being analysis, together with evaluations of estimated glomerular filtration fee (eGFR) and urine albumin-creatinine ratio (uACR).
• Enhancing/sustaining bodily well being. Measures general bodily functioning primarily based on the Medicare Well being Outcomes Survey.
• Enhancing/sustaining psychological well being. Evaluates self-reported beneficiary information concerning emotional well-being, corresponding to frequency of emotions of despair, anxiousness, and different psychological well being situations primarily based on the Medicare Well being Outcomes Survey.

Full technical specs of all CMS Star Score high quality measures will be discovered right here.