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Collaborative Care as a Support to Medicare Star Ratings

July 6, 2023


Collaborative Care: A Strategy for Organizations to Improve STAR Ratings

The Centers for Medicare and Medicaid (CMS) publish the Star ratings yearly to measure the quality of care and services provided to individuals enrolled in Medicare Advantage (MA) plans (U.S. Centers for Medicare & Medicaid Services, 2022). The ratings help Medicare recipients compare plans, choose plans with higher ratings and understand the characteristics of a quality provider. The ratings are also meant to help inform providers about their performance in relation to other providers/systems. Service providers are rated on a score ranging from 12 to 30 based on the number and type of services they offer.

For the years 2022 to 2023, the majority of quality ratings declined, from physical quality measures such as cholesterol screening. Measures such as response to phone calls and care coordination also declined, at a time when patients need the most support. Most providers and organizations saw a significant decline in ratings and stars, leaving consumers to wonder about the quality of care and making care decisions harder.

 One solution to assist providers with meeting quality measures and improving star ratings would be the adoption and optimization of the Collaborative Care model. Collaborative Care is an evidence-based model, supported by over 90 randomized controlled trials, to identify and treat patients with depression and anxiety in healthcare settings. The model was approved for reimbursement by CMS in 2017 with three specific CPT® codes 99492, 99493 and 99494. Subsequently, the codes have been approved by Medicaid in 24 states as well as recognized and reimbursed by commercial plans. Collaborative Care has been shown to impact quality scores and chronic conditions outcomes (Bauer et al., 2019). Patients who received collaborative care for concurrent depression, diabetes, and/or coronary heart disease saw greater improvements in glycated hemoglobin levels, LDL cholesterol levels, systolic blood pressure, and depression scores at 12 months (Ali et al., 2020; Katon et al., 2010). Similarly, significant reductions in body mass index and depression symptoms have been observed in patients experiencing obesity (Ma et al., 2019), as have improvements in pain, fatigue, and overall functioning and quality of life in patients with cancer (Sharpe et al., 2014). Patients receiving collaborative care also report a more positive overall experience with their care (Rugkåsa et al., 2020).

The ability of providers and organizations to not only adopt collaborative care but to recognize the value of collaborative care on their total quality and cost of care, would help to drive quality measures, patient support and star ratings. It is widely recognized that the adoption of collaborative care may be a “lift” for some organizations, however, there are significant resources such as the AIMS Center and Meadows Mental Health Policy Institute to assist and organizations such as Concert Health that provide a turnkey solutions to providers and organizations.


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