Is There an Association Between the High-Risk Medication Star Ratings and Member Experience CMS Star Ratings Measures?

BACKGROUND: Methods to achieve high star ratings for the High-Risk Medication (HRM) measure are thought to result in unintended consequences and to compromise several member experience measures that ultimately put at risk the plan sponsor's Medicare Part D Centers for Medicare & Medicaid (CMS) star rating. OBJECTIVE: To determine if HRM scores are associated with relevant member experience measure scores. METHODS: This is a cross-sectional analysis utilizing CMS 2013 and 2014 plan star ratings reports (2011 and 2012 benefit year data) for Medicare Advantage prescription drug (MA-PD) plans and prescription drug plans (PDPs). Medicare contracts with complete data for all measures of interest in 2013 and 2014 star ratings reports were included (N = 443). Bivariate linear regressions were performed for each of 2 independent variables: (1) 2014 HRM score and (2) 2013 to 2014 change in HRM score. Dependent variables were the 2014 scores for "Getting Needed Prescription Drugs," "Complaints about Drug Plan," "Rating of Drug Plan," and "Members Choosing to Leave the Plan." RESULTS: The bivariate linear regressions demonstrated weak positive associations between the 2014 HRM score and each of the 2014 member experience measures that explained 0.5% to 4% (R-2) of variance of these measures. The bivariate regressions for the 2013 to 2014 change in the HRM score and 2014 member experience measures of interest demonstrated associations accounting for 1% to 8% of variance (R-2). The greatest associations were observed between each independent variable and the 2014 "Getting Needed Prescription Drugs" score with correlation coefficients of 0.21 and 0.29. CONCLUSIONS: HRM star ratings and change in HRM star ratings are weakly correlated with member experience measures in concurrent measurement periods. Plan sponsors may be more aggressive in HRM utilization management, since it is unlikely to negatively impact CMS summary star ratings. Copyright (C) 2014, Academy of Managed Care Pharmacy. All rights reserved.