How to Improve Medicare Advantage Star Ratings

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Significant changes are coming to Medicare Advantage Star Ratings. CMS is quadruple-weighting Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures in contract year 2021, which means the surveys will account for 32 percent of the overall Medicare Advantage Star Rating.

With this increased emphasis on CAHPS, Medicare Parts C and D plans must evaluate and strategize to improve relevant consumer experience measures. These surveys ask consumers about their experience with their health and drug plans and with healthcare providers including doctors, hospitals, and home care agencies. CAHPS surveys are typically collected in the spring, so it is important to implement a strategy now to perform well under the new Medicare Advantage (MA) Star Ratings formula in the 2021 measurement year.

Why Are Medicare Advantage Star Ratings So Important?

MA plans rated four stars and up are eligible for quality bonus payment (QBP) reimbursement. Medicare is slated to distribute nearly $11.6 billion in bonuses — or approximately $450 per member per year — to the highest-quality plans. MA plans that receive value-based reimbursements are required to use the money toward more consumer benefits and thereby have a better product to compete for consumers during the next open enrollment period.

7 Ways to Improve Your Star Rating

By focusing on these seven things, you can elevate the consumer experience and position your plan to increase CAHPS scores and, in turn, improve your Medicare Advantage Star Rating. Customer experience needs to become a year-round focus integrated into other quality improvement activities. Therefore, MA plans will need to take a customer relationship management (CRM) approach to engage with their membership. This requires an investment in CRM technology, real-time analytics, reporting and organizational structure to engage consumers consistently.

1. Ensure Medication Benefits Are Central to the Consumer Onboarding Experience

When a consumer enrolls in your plan, your plan should offer them a detailed onboarding workflow. Dropping the ball here can cause discontent from the start. Make enrollment an engaging, positive experience that focuses on whole-person health and ensures the consumer has ongoing access to their providers and medication.

You can do this by designating specific touchpoints along the way in a variety of channels. During the enrollment process, it is crucial to ensure the new consumer fully understands their benefits.

Typically, a consumer first uses prescription benefits just after enrollment. Because this is usually their first benefits experience, it should be positive. Moreover, if consumers have chronic conditions, it is particularly important that they have a full understanding of their prescription benefits. Use medical and pharmacy claims data to identify medication nonadherence and reach out proactively to consumers with a CRM-modeled tech platform that allows MA plans to connect the consumer to their health plan benefits or other needed resources. Helping consumers understand their benefits and identifying any barriers to care are critical to ensure a positive experience and better outcomes.


2. Develop Targeted Outreach Programs Around Medication Adherence and Preventive Screening

A lack of medication adherence and preventive screening awareness contributes to poor CAHPS scores. Those who have challenges with medication adherence or don’t proactively schedule annual screenings may not rate their experience very highly. If consumers have problems getting their medication, they may blame their health plan. So it is critical to communicate and connect on these two drivers of the consumer experience.

By leveraging analytics tools to stratify data and reach the right consumer at the right time, you can identify plan consumers who fit these descriptions. With this information, you can develop outreach programs to connect with these consumers and advise them on ways to solve their challenges. For example, if a consumer is unable to physically visit the pharmacy, make sure they’re aware of delivery or mail order options. If consumers don’t know these benefits are available, they can’t take advantage of them. Connecting consumers with resources can not only improve access to needed care but also help plans improve consumer experience.

3. Make Every Interaction Count

Incorporate motivational interviewing tactics into your clinical workflow to help your clinicians identify any social determinants of health (SDOH) issues a consumer may have and help connect them with plan benefits or local resources to overcome those barriers. Focus on medication-related measures, which account for 52% of the overall MA Star Rating.

A consumer’s inability to easily access needed care or follow treatment plans may be rooted in nonmedical barriers, such as lack of transportation or trouble affording copayments. For example, if a consumer has a ride to and from a medical visit but not to the pharmacy on the way home, a vital prescription may go unfilled. Build an adherence journey by tackling these barriers to care, and knock out multiple quality measures when there is a tipping point.

Personal health is, of course, a sensitive topic, and many consumers may not feel comfortable sharing their difficulties or asking questions about their available benefits and resources. Providers and experts often refer to something called the “white-coat silence,” a phenomenon wherein patients don’t want to seem uninformed around their doctors. Consumers are typically more willing to talk to a clinician on the phone to help overcome health literacy issues.

4. Be Proactive with Consumer Feedback

It is crucial to solicit feedback from your consumers after each interaction so you can provide evidence that you’re helping. After obtaining input on specific issues from consumers, you can document discrete, detailed follow-ups, illustrating plan support. This requires detailed analytics, technology and reporting to ensure follow-through. The impact will support more positive CAHPS and Health Outcomes Survey (HOS) scores.

5. Communicate Consistently and in Different Channels

Plan communication can be an Achilles heel if you don’t make it a priority. A recent survey found that only 37 percent of plan consumers had received information regarding COVID-19 as of May 2020. With all the misinformation and unknowns surrounding the pandemic, every plan should make a concerted effort to update consumers about care and coverage options. A lack of communication on your part doesn’t sit well with consumers, and they’ll make their feelings known when surveyed.

A solid way of improving the consumer experience is to diversify communication channels based on consumer preferences. Some may prefer digital channels, whereas others want to receive physical mail or a telehealth option. Let them choose to opt in for email and text updates when possible. However, as you diversify, remember that a central strategy needs to drive messaging and its timing at the individual consumer level. Organizational consolidation around communication ensures consistency across all consumers.

6. Make the Right Resources and Information Readily Available

Is your website easy to navigate? Are key topics and resources easy to find? If you ensure your website has convenient and topical information, consumers can find the initial information they need and contact you for more details. Consider adding chat to your website as a useful tool to quickly provide answers to common questions.

7. Train and Empower Your Consumer Care Team

Your consumer care team plays a pivotal role in the consumer experience. When a consumer calls in — team members, whether internal or through third-party vendor support — should have adequate training and be trustworthy to make decisions. Such a model can lead to more first-call resolutions. Ideally, the care team has detailed information at their fingertips in the CRM to overcome barriers to care and improve quality.

How Resolve™ Can Support Medicare Advantage Star Ratings

Resolve™ for Medicare Advantage Star Ratings, an Adhere Platform™ solution, is the ideal tool to help you strategize proactive engagement. It’s the only consumer-centric solution that enables you to optimize scores by addressing 80.5 percent of Medicare Advantage Star Ratings weight relating to medication adherence, quality improvement and consumer experience (e.g., CAHPS).

The platform, offered as a SaaS solution or a tech-enabled clinical service, continuously ingests your CAHPS, pharmacy/medical claims, HEDIS, eligibility and hospital discharge data to target gaps. These predictive analytics are integrated into an intelligent clinical workflow CRM tool to maximize each interaction with the consumer or their provider. Actions taken during these calls directly support CAHPS and HOS survey questions to ensure the consumer experience is tied to care support.

Learn more about Medicare Advantage Star Ratings and Resolve™ by downloading our guide, Raising the Bar on CAHPS Performance.