The Center for Medicare and Medicaid Services (CMS) released its annual Medicare Advantage and Part D Star Ratings last month, and—to be completely honest—the results weren’t great.
For those just seeing this news, the results were the lowest since 2017, with an average rating of 4.04. Only 7% of healthcare members will be enrolled in a 5-star plan next year, down from 22% this year.
Why the steady decline? Two factors largely influenced the results. The first is the most obvious: Members aren’t happy. They’re increasingly selective about their health plans and frustrated by the numerous challenges and expenses associated with healthcare today.
Second, CMS made notable changes this year, including modifying how quality is assessed and introducing new methods of calculating outliers. CMS created greater competition for the coveted bonus payments and raised the bar in achieving member satisfaction.
And with good reason. This is a member’s voice amid the confusing, ever-evolving world of healthcare. We should all be striving to keep members happy. How exactly do we do that? By communicating, listening, and meeting them right where they are in their health journey.
Modernizing the healthcare experience
Given how rapidly COVID accelerated consumers’ use of computers and mobile devices, it shouldn’t be surprising to know that healthcare for seniors requires technology. We’re on our phones constantly. Apps and devices are infused in the very fiber of our culture. Why wouldn’t we leverage apps to connect with members too?
Indeed, it’s apps that personalize the healthcare experience and provide care guidance that members need. The right solution offers appointment reminders, push notifications about important tasks, sends out health surveys to gather additional information about members, provides educational resources to help members make important decisions, and even offers incentives and rewards for completing tasks. It’s not just about bombarding members with communications but making sure those communications are meaningful.
Each of these benefits closes the gap between members and health plans. They help health plans hold members accountable in a way that works best for them. That’s key to improving member satisfaction. At the end of the day, this is all about better connecting with members.
Show customer service staff some love
While apps are an important long-term solution to keep star ratings at a 5-level ranking, health plans can also implement other changes to increase their plan rating in the future.
Much of the star ratings are tied to Consumer Assessment of Healthcare Providers & Systems (CAHPs) surveys, which carry a heavier weighting than traditional HEDIS measures. Administered by CMS, these surveys ask members to rate their experience with health plans, providers, and other healthcare facilities. Target improving these survey results and you’re halfway to solving for member satisfaction. More specifically, you should engage your customer service team:
- Focus your attention on customer service staff as you begin efforts to improve CAHPs surveys. Customer service has the most interaction with members and fields most of the complaints and grievances. That means they need to be the most informed.
- Make sure they are aware of plan changes and have a clear process in place to resolve complaints. Give them as much information as possible so they can better assist members to help them save time and money.
This might sound like a small solution that won’t make a big difference—or something you think is already in a good place. Don’t make that assumption. Too many organizations don’t make customer service a priority, instead dismissing it to drive resources somewhere else. Empower your customer service staff, and thus your members, and you’ll reap the benefits.
Leverage data from hidden sources
Consider using risk stratification to target high-risk members, such as those with diabetes, high blood pressure, or other chronic conditions. These members are the most likely to have costly Medicare needs, and they’ll be big influencers on CAHPs surveys. Risk stratification can be easier to do with the right enhanced data analysis software.
A few other places you can find valuable data to improve star ratings: disenrollment surveys, complaint tracking modules (CTMs), customer service data, and social determinants of health data. Take a look at data from each of these to gain a better understanding of why members leave plans and their biggest complaints or grievances. Then work to resolve those issues.
Pursue every avenue to increase ratings
This is only the tip of the iceberg. For a deeper dive into how to improve your star rating, keep an eye out for our upcoming eBook, Seven Strategies to Boost Star Ratings. To be notified when it comes out, sign up here.
If you want to get started today, our team at Zelis already has solutions in place to help. Connect with us to learn more.