Over the last four cycles of the CMS Stars program, the 4 Star cut points for the HOS and CAHPS-based measures have remained relatively stable. Since 2017, some measures such as Improving or Maintaining Mental Health have seen a slight decline from a score of 85 to 82 to achieve four stars. Unlike HEDIS measures and medication adherence measures, these member experience measures have not seen the drastic cut point increases. Take, for example, measure C07, the Adult BMI assessment. In 2017, a score of 90 resulted in a four-star rating. Without improvement by 2020, the same score would now result in only a two-star rating.

CMS: Trends in Part C & D Star Rating Measure Cut Points
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CMS: Trends in Part C & D Star Rating Measure Cut Points
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In evaluating the four-year historical trends among the categories of measures, Medicare Advantage plans have increased performance in prevention and medication adherence measures. At the same time, the member experience, as indicated by cut points, has remained relatively flat. When considering this analysis, the reasoning behind weight changes for member experience measures communicated by CMS in the 2021 call becomes more apparent. By increasing the weights and thus increasing the importance of member experience, CMS is hoping that the industry, at large, improves member experience.

Prioritize HOS Measures

As plans start to shift their attention to the CAHPS-based measures focusing on member experience and engagement, it is important to remember the Health Outcomes Survey (HOS) measures. While the HOS might seem tangential, both surveys ultimately measure the member’s journey with a health plan.

While the weight of the HOS based measures was not impacted in the 2021 Call Letter, the Improving or Maintaining Physical and Mental Health measures are still triple weighted. In combination with the other HOS impacted measures, approximately 12% of the overall score is attributed to HOS results. Historically, these measures have rarely been considered a viable means of significantly improving a Star rating. The HOS has value beyond the five HOS measures in Medicare Part C.

Smarter Engagement

Research has consistently indicated that patient-reported HOS health information is tied to health outcomes and member satisfaction. The HOS can provide invaluable data on the biggest opportunities for score improvement. When leveraging a continuous year-round digital tool, plans can efficiently get a sense of their members’ health and satisfaction, and quickly flag areas of improvement. Perhaps even more useful, the plan can rethink their communication with members. Rather than bulk mailing pamphlets that few members read, a digital tool can show plans the areas in which specific members need help. Plans can then perform targeted outreach on these members, with communications tailored bespoke to the needs of each member.

A digital engagement tool provides value to the member in and of itself. The member receives immediate feedback on their health based on their input. This instant result encourages the member to act by communicating with them when they are already engaged and giving them the means to learn and improve their health.

HealthMine is a leading engagement and reward solution, empowering individuals to take the right actions to improve their health. We offer a digital engagement solution tool that can be customized to best meet the needs of any plan. Through this two-pronged approach of providing plans with critical member-specific information, and individual members with their own best means of improving their health, the HealthMine Member Engagement Module is a new paradigm for improving Stars ratings. This module can operate alone or combined with HealthMine’s other modules provide a seamless experience for your members.

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

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.

Brennon Williams is a Project Manager for Clinical Insights at HealthMine Inc. He has extensive experience using technology to improve clinical platforms and member-focused digital tools.

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