Disclaimer: Virgin Pulse and HealthComp are now Personify Health
By 2050, there will be an estimated 85.7 million adults ages 65 and older living in the U.S., accounting for approximately 20% of the U.S. population.1 This growth has made the Medicare Advantage market an attractive one for insurers, leading to a crowded marketplace offering the average Medicare beneficiary 39 Medicare Advantage plans to choose from in 2022. (That’s more than double the number of plans per person in 2017!)2
One way Medicare Advantage and Medicare Part D prescription drug plans can set themselves apart in the market is by achieving high Star Ratings. The Star Rating system benefits members by helping them identify high-quality plans (and in fact, most Medicare Advantage members are enrolled in 4 and 5-Star plans). They also contribute to a plan’s financial success, as plans with 4 stars or higher benefit from bonus reimbursements and 5-Star plans from the ability to market year-round.
The secret to improving, and maintaining, high Medicare Star Ratings requires a year-round effort to drive better member experiences, higher engagement in preventive care and chronic condition management, more responsiveness to customer complaints, and better transparency around prescription drug costs. That’s a lot of work to oversee!
To help Medicare Advantage plans improve Star Ratings, we asked our member engagement experts to share insights on what they are seeing work with our clients. Here are 4 Medicare Star strategies they recommend.
Star Rating strategy #1: Don’t wait for CAHPS scores to address negative member experiences
With Star Rating measures becoming quadruple weighted for patient experience, MA plans have to make improving these measures a critical component of their overall Star Ratings strategy. The challenge with waiting for CAHPS scores to act, is that CAHPS scores is that their results are released later in the year and are generic in nature, ultimately giving plans little guidance to make an impact for the following year.
Smart plans are not waiting for CAHPS results. Instead, they are proactively implementing pre-CAHPS or pulse surveys outside of the blackout period to gain a more timely picture of member challenges and sources of dissatisfaction.
With surveys like these, plans also gain the ability to know which specific members are experiencing challenges so they can immediately act on and respond to their individual needs and concerns. This makes members feel seen and heard, improves satisfaction, and ultimately can boost member experience Star Ratings scores.
Star Rating strategy #2: Treating members like VIPs with a personalized, year-long experience
Member experience reflects the big picture of all interactions a member has with a plan and providers. While plans don’t oversee every single, they can play a part in facilitating better ones throughout the healthcare experience. For example, with thoughtful outreach plans can educate members about physicians are in-network so they aren’t caught with surprise out-of-network costs down the road.
Thinking about member experience this way, it’s clear to see that the work starts well before coverage begins. Leading plans know this and have implemented thoughtful member journeys that make it easier to understand benefits, ensure they know how to use them, and educate members about how to leverage all available resources to support their health and wellbeing.
One way to get off on the right foot is creating a digital-first experience, specifically using technology and multi-channel communications tools to create a personalized welcome and onboarding experience to reinforce the member’s decision to enroll.
Engagement initiatives can’t end there. Once coverage starts, data, including SDOH insights, predictive analytics, and technology like a health and wellbeing platform can be used to nudge next best actions throughout the year.
When a member receives reminders to complete things like a diabetes eye screening, they are taking more control of health, managing conditions, and boosting quality scores that roll up to your overall Star ratings. Another example of how to engage members is by using personalized outreach to promote and boost enrollment in supplemental benefits for eligible members.
Star Rating strategy #3: Identify High-Risk Members for Missed Appointments and Encourage Health Actions
Some members are more involved in health than others, while others are more likely to miss an appointment (even if they know they should make it happen). Plans can make a big impact on closing gaps in care and improving quality measures for things like preventive care, cancer screenings, adhering to recommended medications, and chronic condition management appointments with targeted outreach.
Consumer data, with SDOH insights, and predictive analytics are proven to help plans identify with up to 90% accuracy which members are more likely to have a care gap. For example, did you know that a person’s relationship status and commute length are direct indicators of medication adherence? When plans know who is most likely to miss important appointments, they can effectively get ahead of care gaps by using targeted, multi-channel and multi-cycle campaigns to remind members and activate them to take desired health actions.
Star Rating strategy #4: Get creative about using incentives to drive health actions
Rewards and Incentives often get questioned as an effective tactic, but they are a useful tool in driving next best actions and sparking behavior change. In a recent survey Personify Health conducted, 24% of Medicare Advantage beneficiaries said they aren’t motivated to make any lifestyle changes or try something new, but 43% would engage in healthier behaviors if they were financially rewarded (e.g., gift card, premium discount).
The key to using incentives is to use them strategically, and creatively. Plans must decide which high-value actions they want to reward, what reward type and value to offer, and how to fulfill them. When deployed in this manner, rewards deliver results.
For example, one of our clients decided to use rewards to incentivize members to close gaps for 3 diabetes recommended screenings. Each time they came for an appointment (an annual eye, blood sugar and kidney screening) they would receive a $20 gift card.
When they completed all three, they received a bonus $20. Adding that bonus was a great incentive to complete all three appointments, and it drove 20% of targeted members to do just that. Again, this is great for helping members manage health, and it helps plans boost Star Ratings by closing important gaps in care.
How are Medicare Star Ratings calculated
Medicare Star Ratings are determined based on a plan’s performance across several domains, including health outcomes, preventive care, member experience, plan responsiveness, and customer service.
These ratings are compiled from data collected through healthcare provider reports, member satisfaction surveys, and regulatory compliance reviews. This comprehensive assessment ensures that the ratings provide a reliable indicator of a plan’s overall quality and service.
How do health plans improve Medicare Five-Star Ratings?
Improving a Medicare Five-Star rating revolves around several core strategies, including enhancing healthcare outcomes through effective disease management and preventive care programs, improving member satisfaction through personalized services and responsive customer support, and ensuring transparency and accuracy in healthcare cost and coverage information.
Continuous quality improvement processes, such as regular monitoring of performance metrics and implementing feedback loops for service enhancements, are vital in aspiring for the Five-Star rating.
By focusing on these strategies and areas for improvement, health plans can elevate their service quality, member experience, and ultimately their Medicare Star Ratings.
Boost Member Experience and Star Rating Strategies with Personify Health
Personify Health makes each member feel like your health plan is customized to them. We treat each member like a VIP with a personalized member engagement platform that drives year-round satisfaction and 5-star ratings. Learn more about what we can do for you.
You Might Also Be Interested In:
The Health Plan of the Future – What Older Americans Want
3 Ways to Get Members to Close Gaps in Care
Top Secrets of a 5 Star Health Plan
[1] https://www.americashealthrankings.org/learn/reports/2021-senior-report/introduction
[2] https://www.kff.org/medicare/issue-brief/medicare-advantage-2022-spotlight-first-look/