Tips for Increasing Medicare Star Ratings

Changes to the Centers for Medicare & Medicaid Services (CMS) Star Ratings formulas are coming – are you ready? One of the biggest shifts is the heavier weighting of member experience, sourced from the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey. For example, for the 2021 plan ratings CAHPS measures will move from 1.5 to 2x weight. And their impact on overall Star Ratings will only grow as they move to a 4x weight in 2022 and 2023.

 For example, research from Navigant shows that a 1-Star increase in rating was associated with an 8-12% increase in beneficiary enrollment in the year following the increase. Furthermore, an improvement from 3 to 4 Stars should result in revenue increase of between 13.4% and 17.6%, which would mean between $12 million and $16.2 million in revenue increase for a plan with 9,600 members.

As engagement and activation experts, Virgin Pulse has a long track record supporting Medicare member experience. Here are some tips on how to improve your Star Ratings by addressing the member experience, closing gaps in care and driving medication adherence.

Proactively solve member’s problems with personalization

As a health plan, you have a lot to say, from educating members about finding in-network care, to information about what services are available, and how to access and use them, to encouraging actions like refilling a prescription. But blasting all of your members with the same generic information is not the best way to connect with them. In fact, it might do the opposite, overwhelming members and ultimately leading to them to tune out your messages.

Instead, build a better member experience by creating an outreach strategy that treats members as individuals by reducing the noise and providing resources and reminders that are relevant to them.

Leverage consumer data and social determinants of health factors

As the pandemic proved, what happens outside of a clinic significantly impacts health status and risks. Thus, relying on clinical data alone puts you behind the ball. When you add in consumer data including SDOH factors, you’ll gain insight to the whole member and increase engagement leading to lower claims costs.

Applying predictive analytics to this data, like Virgin Pulse does for its clients, delivers actionable insights like who’s at risk for missing a medication refill or skipping an annual preventive visit (today or in the future), as well as what communication channel they prefer and who is most likely to respond to outreach. Applying these insights to outreach has driven a 20% to 50% lift in engagement for our clients.

Go beyond single-channel, single outreach

To be heard in today’s disconnected world, people also need to receive messages more than once, and through more than one channel. Did you know that using 4 or more channels can increase effectiveness of outreach by up to 300%? 

Nurturing members throughout the year with carefully coordinated campaigns that extend over a period of time will help you effectively connect with members, drive action, and build loyalty. One example of what this can look like is using IVR, email, text and direct mail during the welcome and onboarding process, and moving to using email, in-app notifications and text messages to remind members to close gaps in care or take actions like refilling medications. This increase can lead to 50% lower claims costs for a population who are already heavy users.

How is all of this possible?

If this seems like a lot of work to orchestrate, that’s because it is! The good news is that Virgin Pulse can do all of this for you. Contact us to learn more about how we can help you increase your star ratings.