2021 Medicare Advantage Star Ratings Changes and CAHPS Improvement

Centers for Medicare and Medicaid Services (CMS) has announced some key changes to the Medicare Advantage (MA) Star Ratings formula for contract year 2021, which impact 2023 Star Rating scores. The changes put the spotlight and emphasis on Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, which are usually conducted annually each spring. CAHPS scores will be quadruple-weighted, which means they will represent 32% of the overall Star Rating weighting for contract year 2021.

CAHPS surveys ask beneficiaries (or caregivers) about their experience with, and ratings of, their providers (e.g., hospitals, home health care, hospitals) and health plans. The consumer experience entails all the interactions an individual has with your plan and their perception of whether those interactions are overall positive or negative. Their experience breaks down to three things:

  • How easy it is to access care
  • Communication from providers
  • How well consumers understand medication information

CMS makes a point to note that experience is not equal to satisfaction. The key distinction here is that CAHPS surveys want to know the consumer’s opinion of the experience, not if they were satisfied. Although experience and satisfaction are adjacent, they aren’t the same thing. It’s possible for a consumer to find their experience acceptable but not be satisfied with the results. Ideally, you want to provide a good experience and keep consumers satisfied but keep this difference in mind.


Strategies for Improving CAHPS Survey Results

There are several consumer experience aspects of the CAHPS that health plans can improve. First is customer service, which is critical to the patient experience. To excel at service, your health plan must ensure that every interaction with consumers is meaningful. Do more than just respond to the consumer’s surface-level needs. Go deeper by asking questions about any social determinants of health (SDOH) issues. Take a practical approach to serving and communicating with plan consumers. Don’t assume they understand all the benefits that are available through the plan.

Beyond service and clear communication, the other most impactful area relates to how well the consumer understands and has access to prescriptions. Access to and understanding of their medications are directly tied to medication adherence, which is another significant aspect of MA Star Ratings. Medication-related measures account for 52% of the overall Star Rating, so it makes sense to make adherence and CAHPS a dual focus when engaging with consumers. You may have some procedures or programs in place to simultaneously address adherence and CAHPS, but it’s often hard to manage both at scale without streamlined customer relationship management (CRM) system.

The Challenge of Mastering CAHPS for Health Plans

Consumer experience depends on many factors outside of single events. Plans must be proactive and develop a consumer-centric approach to solve challenges. Ultimately, you need consumer experiences to be the foundation of all interactions.

Many plans may hit hurdles in organizational design because the process of developing and enhancing the consumer experience includes multiple stakeholders. In developing a strategy to perfect the consumer experience, you need everyone in the organization to have access to key information needed to overcome barriers and connect consumers with needed care. This ensures you can chart a path to get from where you are now to a truly holistic, consumer-centric end result.

The other significant challenge health plans face is how SDOH issues around accessibility impact the consumer experience. Remember, experience is about perception, and plan members often aren’t aware of all their options. When you take a data-driven approach to identify these consumers, you can increase their awareness by connecting them with available resources that are pertinent to their individual situation. For example, prescription delivery services not only resolve medication nonadherence but also improve access to needed care.

Planning for 2021 to Improve 2023 Scores: Is Your Plan Prioritizing CAHPS?

Every health plan prioritizes good service, but a given plan’s idea of good may not be a holistic and consumer-focused approach needed to optimize CAHPS performance. Historically, plans used a systematic approach to consumer engagement and relied on antiquated case management tools. It’s laborious and ineffective to engage consumers without modern analytics tools. Operating under a manual approach can never measure up, because only data-driven tools can ensure you reach the right consumers at the right time, efficiently and effectively.

Improving CAHPS Scores and All Consumer Experience Measures Requires Data-Driven Tools

With the MA Star Ratings weightings shifting focus to CAHPS, you’ll want to center your efforts on improving consumer experience measures.

Beginning in the 2021 contract year, CAHPS measures represent 32 percent (32%) of the overall Star Rating. Navigating how to improve these areas can be complicated, but Resolve™ for Medicare Advantage Star Ratings, part of the Adhere™ platform, is an end-to-end tool that makes consumer-centric outreach for CAHPS improvement a seamless process.

Whenever you have data, there’s always the opportunity to leverage it for better outcomes. You simply need the right tools that will allow you to use predictive analytics to link CAHPS with other important measures, such as those related to medication adherence.

Resolve is a consumer-centric solution that addresses 80.5 percent (80.5%) of MA Star Ratings measures, with a particular focus on improving medication adherence and CAHPS results. With a powerful solution like Resolve, plans have the opportunity to create more meaningful touchpoints with consumers to alleviate SDOH barriers and deliver better value-based care. This, in turn, better positions plans to reach the 4-Star threshold needed to qualify to QBP value-based revenue needed to succeed in the competitive Medicare Advantage market.

Resolve is available as a software-as-a-service (SaaS) platform or as a tech-enabled clinical service.

Small Initiatives to Support Awareness and Consumer Experiences

Along with implementing a data analytics platform, plans can also do small things to improve the consumer experience, including:

  • Ensure information is accurate and up to date on your website, member directories and pharmacy resources.
  • Communicate in multiple channels—traditional and digital—about any changes to the plan (e.g., COVID-19 benefits or pharmacy delivery services).
  • Create targeted campaigns to boost health plan literacy, so plan consumers are aware of all their benefits.

Learn More About How to Improve CAHPS With Resolve

Investing in an intelligent data analytics platform like Resolve enables you to target consumers at high risk of medication nonadherence and connect them with available health plan benefits and community resources to overcome SDOH barriers.

To learn more, read our guide, Raising the Bar on CAHPS Performance. Download it today.

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