The Centers for Medicare and Medicaid Services (CMS) released the 2023 Medicare Star Ratings last week; there was a notable drop in the number of plans that scored 4+ stars compared to the previous year. While this was expected due to the ongoing pandemic and associated changes (i.e., removal of the disaster provision), plans continue to focus on improvement in quality of care and service.
Improving Star Ratings is a year-round effort in building member engagement, trust and satisfaction; partnering with the right digital health solutions is crucial in getting the leg up on Star measures going forward.
When considering strategies to improve Stars, there are 3 key areas Medicare Advantage plans should evaluate: care gaps, medication adherence and member experience. To move measures, and ultimately improve quality, equitable care, plans need to focus on engaging members on a regular and individualized basis.
Health Plans that invest in member engagement and analytics solutions gain insights into members’ health status and experience. These insights enable timely interventions and reminders to seek care, refill medications or schedule appropriate testing. Member engagement that allows two-way communication between the plan and the member means (near) immediate feedback and understanding of which gaps remain open and how one is experiencing their care.
The world is still recovering from the social and care gaps that COVID-19 created and exacerbated. Gaps are evidenced in this year’s Stars; solutions must be able to address the “why” when addressing care gap closure.
Everyone’s story is different, but there are common themes plans should consider when analyzing care gaps:
Collecting these data points and segmenting gaps in care by factors, such as those listed above, is a concrete step plans can take in moving towards more equitable, quality care.
Medication Adherence is a focal point for many health plans, with good reason. Medication non-adherence contributes to widening care gaps and negative health outcomes. Medication adherence impacts over 40% of Star Ratings, including measures like: Controlling Blood Pressure and Diabetes Care – Blood Sugar Controlled.
Health plans have been working for many years to support medication adherence, instituting medication home delivery & synchronization programs, reminder programs and others. The expansion of digital health capabilities has afforded members the opportunity to engage with their health plans beyond pamphlets and postcards. Daily check-ins through digital platforms can help build routine and allow for real-time intervention when necessary.
In Stars 2023, member experience measures elevated to 4x the previous weighting, highlighting the importance of communicating regularly with your members. Where can you start? Understanding and setting member expectations. The best way to set member expectations (and exceed them) is through specialized member benefits focused on personalized care and attention.
To get a pulse on member experience and expectations, health plans may complete off-cycle CAHPS-like surveys. Partnering with digital health solutions that promote engagement, adherence and connection can have a positive impact on member experience and satisfaction. Allowing members to give feedback regularly encourages connection, and they feel seen and cared for by their health plans when they need it.
Quality metrics are ever-changing, and the biggest trend in quality improvement is health equity. Committing to a mission of health equity means addressing the social determinants that contribute to care gaps, gathering extensive demographic data and creating culturally relevant member experiences.
NCQA proposed HEDIS measure changes, including several new measures and expansions to promote health equity. The Social Needs Screening and Intervention measure, expanded race and ethnicity stratifications and updates to encourage gender-affirming healthcare. These updates improve the evaluation of care and services while focusing on need-based solutions.
Social needs screening is not without its barriers. The quality of response rates can be impacted by the levels of trust and transparency members feel they have with their health plans. Low response rates prevent the plan from seeing the full picture of the member experience. A more personalized and engaging member experience lays the groundwork to connect on important issues like food insecurity or lack of housing.
Wellth’s partners at Priority Health celebrated the highly desired, 5-star rating for Stars 2023. Through our partnership, Wellth provides an easy-to-use program focused on improving member engagement and experience with daily check-ins and behavioral economics-supported habit change.
With over 84% of Wellth members actively checking in every single day, there are daily opportunities for engagement with members from medication adherence, medical device adherence, care gap closure reminders, and social needs screening.
Priority Health members saw:
As Wellth continues to grow alongside our partners, we continue to make advancements and improve the experience to the needs of our customers and their members. Wellth has launched initiatives for closing care gaps, in-app surveys, and member journey personalization with great success. Additionally, Wellth’s live support team is able to create multiple touch points with members in order to encourage open communication and allow for opportunities of timely intervention. With these supports in place, Wellth is able to bridge gaps between members and their care plans.
There is a lot to gain with increasing (or maintaining) favorable Stars scores: member retention, bonus reimbursements, marketability, and plan growth. And there is a lot to lose!
Contact us to learn more about how we can support your future Star Ratings.
