The HEDIS-based measures have long been the focal point of the Star Rating Program for Medicare Advantage plans. Even as CMS made changes to the program, there remained a consistent correlation between strong performance in HEDIS-based measures and a 4-Star Rating. For many plans, the strategy to improve HEDIS performance was through multiple campaigns and member touches. In recent years, plans have transitioned to consolidated communications to address all HEDIS gaps for a member. The underlying approach, even in a consolidated communication plan, remains campaign based.

Impactful Changes on the Horizon

While campaign-based strategies often work to improve performance on HEDIS-based measures, this strategy is less likely to be effective in addressing the overall member experience – and the tables are set to turn. Due to the COVID-19 global pandemic, CMS announced that previous CAHPS results would be included in the 2021 Star rating, which means most plans are operating with member sentiment data from two years ago. Many plans will be making critical strategic decisions based on antiquated data that is no longer applicable or relevant to their current population. Beyond that, CMS has made it clear in the 2021 rules changes that member experience measures are moving to a weight of 4. This weight change will give CAHPS-based measures a stronghold on a significant percentage of the Stars Ratings program. CMS expects that this change will reduce the overall number of plans earning 4 or more Stars.

With these impending changes, it is critical that plans collect member sentiment through a well-constructed mock CAHPS survey. This data will provide plans with a line of sight into prospective areas of improvement for member experience moving forward. CAHPS has replaced HEDIS as the focal point of the Stars Program, and swift strategic action will allow plans to implement initiatives to improve the member experience for the 2021 plan year.

Moving Forward With the Right Partner

For plans, the solution to taking these upcoming changes in stride will be by planning now for CAHPS-based interventions and focusing on member experience. The traditional approach to gleaning insight into CAHPS performance is through a mock CAHPS survey distributed through physical mailings and phone calls. These approaches provide limited scalability due to the high cost and inefficiency. Digital surveys offer a scalable, efficient, and relevant solution. These surveys are distributed through digital communications and can be developed so that irrelevant questions are suppressed based on member responses, which improves member experience. Further, digital surveys yield results in real-time, which allows plans to quickly receive data for a larger proportion of their membership than with a physical survey process. If developing and executing a strategy to improve member experience seems like a daunting task, we at HealthMine are here to help.

HealthMine is a leading engagement and reward solution, empowering individuals to take the right actions to improve their health. As such, we assist plans with transitioning from a campaign-centered approach to continuous member engagement and a focus on member experience. We are a single configurable solution offering multiple modules that provide a seamless experience for your members. HealthMine’s communication package is reviewed with the clients as a part of the implementation, eliminating the need for our clients to create custom communications. Through a multi-modal registration strategy, we can maximize the proportion of your plan’s members interacting with our platform. Our member experience platform can provide members a digital mock CAHPS Survey, Net Promoter Score, and a mini-Health Outcomes Survey. Adding our digital solution to your member experience strategy will eliminate your reliance on recycled CAHPS data and produce real-time data on member sentiment. Plans can utilize this member-reported information to improve the member experience and ultimately improve performance on CAHPS measures.

For more information on how to plug into the digital surge and improve member experience, feel free to contact me at

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.

Angela Leduc is a Senior Healthcare Analyst at HealthMine Inc. and University of Michigan – trained epidemiologist with experience in Maternal/Child Health and HIV/AIDs research, Advanced Analytics and Population Health.

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