Significant changes to Star Ratings are in store for 2023, which will directly impact health plans in many ways. For example, their ability to market to members year-round. Included are three things health plans should act on now to maintain or boost quality scores, growth and retention plan, and financial health.
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) announced several changes to Medicare Advantage that will take effect in 2023. The changes are aimed at advancing CMS’s vision for health equity, driving comprehensive, person-centered care, and promoting Medicare affordability and sustainability. They include updates to Medicare Advantage capitation rates, Part C and Part D payment policies, and Star Ratings.
Star ratings should be of particular interest to health plans, health systems, members, and patients alike. Star Ratings reflect the quality of care a health plan delivers, and a large portion also reflect a patients’ experiences with health plans. As such, member or patient experience can play an important role in a plan’s quality, member retention, and recruitment strategies.
The Star Rating system helps Medicare beneficiaries, their families, and caregivers compare the quality of Medicare Advantage and Part D prescription drug plans. Star Ratings reflect the experiences of people enrolled in those plans by incorporating member feedback from CAHPS and HOS surveys into a plan’s overall Star Rating. CMS releases the Star Ratings annually in order to provide people with information to help them make informed choices about which Medicare plan is best for them.
Significant changes to Star Ratings are in store for 2023, which will directly impact health plans in many ways (eg, their ability to market to members year-round). Here are three things health plans should act on now to maintain or boost quality scores, growth and retention plan, and financial health.
- Quadruple weighting of member satisfaction scores
Star Rating measures will become quadruple weighted for patient experience in 2023, making these measures a critical component of a health plan’s overall future Star Ratings strategy. A proven way to boost member satisfaction is by using data, technology, and multi-channel communications to create a personalized welcome and onboarding experience, which can then be leveraged as a springboard for year-long member engagement. JD Power’s 2021 US
Medicare Advantage Study found that health plans that communicate effectively with members see higher satisfaction rates. This includes successfully engaging with members to answer questions and / or solve problems, making sure members fully understand their out-of-pocket costs, providing health education, delivering useful reminders for preventive services, and other communications. The more often a member feels seen and heard, and uses their benefits, the happier they will be.
- Future health equity quality measure for Star Ratings
During the comments period, CMS solicited feedback on the development of a Health Equity Index to assess how plans screen for social needs such as food insecurity, housing insecurity, and transportation challenges. While a quality measure may need time to come to fruition, there are several steps health plans can take now to better address the social needs of vulnerable populations.
For example, with social determinants of health data and predictive analytics, it is possible to identify which members are likely to have problems related to education and literacy, lack of material resources such as access to healthy food or transportation, among other social needs. With this type of information, health plans can intelligently develop their plan design and, down the road, leverage personalized communications and targeted outreach to offer members relevant programs to help close care gaps by meeting their immediate needs and / or removing barriers to care.
- A return to pre-pandemic quality measure calculations
During the COVID-19 pandemic, CMS allowed health plans to use carryover quality measures for 2021 and 2022, resulting in a higher-than-average number of high scores. For example, 74 health plans earned a five-star rating in 2022 compared to just 21 in 2021, according to CMS. This has been great for member retention and reimbursement levels, but what will happen in 2023 when these concessions end?
Health plans need to act now by executing effective member engagement strategies to drive members to take actions that can help improve their health, such as scheduling a preventive care visit or completing a missed screening. Greater engagement and action now can lead to future higher member satisfaction scores for their plans.
There are a lot of changes coming when it comes to Star Ratings, and keeping them high will be a challenge, but not impossible. Member expectations are at an all-time high, with 80% of Medicare Advantage members enrolled in a plan with 4 or more Stars. With healthcare consumerism on the rise, it’s important to make a positive impression early on in the member journey and provide actionable steps to help improve their health and wellbeing. Innovative health plans can begin taking steps now to better engage and support their members and help drive improvements in patient outcomes and Star Ratings alike.
Data, predictive analytics, and multi-channel, multi-cycle outreach are critical for addressing each of these areas. They can drive higher engagement and actions like closing gaps in care – which can help health plans maintain and improve Star Ratings. A digital-first approach should be implemented from day one of a member signing up with a plan and continue throughout the lifetime of their membership. This should include creating a personalized welcome and onboarding experience, and developing and regularly sharing timely, easy-to-understand information aimed at supporting a member’s individual health and wellness journey.
Multi-channel communications should be informed by deep, data-driven insights into the member’s life, experiences, and social needs, and should be delivered in the channels that they are most likely to engage with (eg, email, automated voice calls, text message), based on their personal preferences. This approach can help boost member satisfaction now and for years to come.
April Gill is executive vice president and general manager of Health Plans & Health Systems at Virgin Pulse.