For Medicare Advantage plans, the HEDIS-based measures have been the focal point of the Star Rating Program for years. Even as CMS made changes to the program, strong performance in these measures was essentially a formula to reach a 4-Star Rating. For many plans, the strategy to improve HEDIS performance was through multiple campaigns and member touches. While this approach was successful for many plans, it often meant members would receive multiple mailings throughout the year. In recent years, plans have started to consolidate communications to address all HEDIS gaps for a member, but the underlying approach is still campaign based.

Recommendations Become Reality

On May 13, our COO, Amy Lung, and Stars Consultant, Rex Wallace, conducted a joint webinar to address the changes to the Star Ratings program because of the COVID-19 global pandemic as well as proposed CMS regulatory changes. One of the key themes was the importance of the member experience. CAHPS and member experience measures officially moved from a weighting of 1.5 to 2.

Although CMS had been publicizing the change in previous Advance Notices, it came as a shock, as the change would be implemented during a year when the CAHPS survey was suddenly halted. Previous CAHPS results included in the 2020 Star Rating are going to be used for the 2021 Star Rating. Additionally, there has been skepticism that CMS would increase CAHPS and member experience measures to the proposed weight of 4.

Now CMS has made it clear in the 2021 rule changes that member experience measures are moving to a weight of 4.

With this weight change, CAHPS-based measures constitute the greatest percentage of the Star Ratings program. CMS has implied that this change will reduce the number of plans earning 4 or more Stars. This redistribution of Star Ratings results in cost savings of 3.65 billion dollars in quality bonus payments over 10 years. This savings offsets cost increases from Medical Loss Ratio regulations.

Path Forward with the Right Partner

Plans should evaluate how the 2021 rule changes impact their overall Star Ratings and the resulting financial impact. Plans need to understand that HEDIS is no longer the focal point of the Stars Program; CAHPS is now the focal point of the program. Plans must start planning now for CAHPS-based interventions, as they need to focus on the member experience. Now is the time to switch from campaign-based initiatives to continuous member engagement.

HealthMine is here to be your thought partner and assist plans with switching from a campaign-based approach to continuous member engagement. We are a single solution offering multiple modules, providing a seamless experience for your members. Our member experience platform can provide members a digital mock CAHPS Survey, Net Promoter Score, and a mini-Health Outcomes Survey. Plans can utilize this member-reported information to improve the member experience and subsequently improve performance on CAHPS measures.

Please look for my next blog where I discuss the benefits of digital surveys. For more information on how to plug into the digital surge and improve member experience, feel free to contact me at james.haskins@www.healthmine.com.

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James Haskins is Director of Government Programs at HealthMine Inc. with 13 years’ experience in Healthcare Effectiveness Data Information Set (HEDIS), Medicare Star Ratings, Medical Record Review, and Data Analytics.