It’s easy to get lost in the sea of constant program and measure changes to the formula for calculating Star Ratings for Medicare Advantage (MA) plans. Savvy Stars teams navigate by relying on the big picture: Keeping members healthy and meeting expectations for their care.
Nonetheless, recent changes to the Star Ratings program are focusing attention on several critical areas, which Healthmine presented in detail in a recent webinar in partnership with Pulse8. During this webinar, we asked attendees to tell us—of these areas of concern—what keeps them up at night.
The top answer, picked by 42.7%, was the doubling in weight of the Consumer Assessment of Healthcare Providers & Systems (CAHPS) measures, a gauge of customer experience.
The second-most common was a gaggle of measures known by the acronyms TRC/FMC/PCR at 12.2%; followed by provider data interoperability at 8.5%; and the reduced value of HEDIS measures at 4.9%.
Nearly one-third, or 31.7%, said all of the above, which is not surprising, given how hard it can be to stay on top of the changing regulations while prioritizing the most important elements that feed into Star Ratings.
To help you focus, prioritize, and act, here is a look at each issue in more detail and an overview of actionable steps you can take to position your plan for a strong ratings season.
Increased Weighting of CAHPS Survey Measures to 4x
Since the start of 2021, consumer experience measured by CAHPS makes up 33% of the Star Ratings calculation for Medicare Advantage plans—and this is also true for 2022.
Plans should continue evaluating what they need to be doing today in order to perform well on CAHPS surveys and measures—and what steps will have the biggest impact.
We can sum it up this way: Don’t be afraid to ask. Our motto this year is, “Find the right members, fix their problems.” Let’s break that down into action steps:
- Continuously ask members about their experiences and for their opinions through mock CAHPS surveys and questionnaires modeled after the Health Outcomes Survey (HOS). While plans may prefer a high-touch approach, budgets are not unlimited. Digital surveys are low-cost and instant—don’t wait for paper surveys or follow-up phone calls. It takes substantial time to record responses and sift through the answers, and you may lose the opportunity to turn potentially negative experiences into positive ones.
- Invest in digital tools or partners that can capture ongoing feedback and deliver it back to your team in real time, allowing you to take immediate action when members flag something as a problem. Using digital and IVR mock surveying to get as much data as you can means you can spend time and money on the interventions that solve the problems you uncover.
- Treat every interaction with members as an opportunity to listen and learn. Don’t be reluctant to ask what they need help with or what more you can do for them because the answer may be unpleasant. Invite the feedback willingly and give them an easy way to respond. Members appreciate the opportunity to share, particularly given the challenges they may be facing post-pandemic in accessing health care.
- Consider enhancing your rewards programs to incentivize members to complete surveys and share their experience with your health plan. If you don’t have a reward program today, create one ASAP.
The bottom line is that strong CAHPS scores do more than earn stars. They have been shown to drive down costs, increase member retention, and help ensure members get the right care. So, any investment you make in this area is a worthwhile one.
Introduction of Other Treatment Measures: TRC, FMC & PCR
This collection of acronyms represents evidence-based quality measures that are being added to Star Ratings for the first time in 2022. TRC stands for Transitions of Care; FMC for Follow-Up After Emergency Department Visit for People with High-Risk Multiple Chronic Conditions; and PCR for Plan All-Cause Readmissions.
They essentially measure follow-up care for members after they are discharged from an acute care setting or visit an emergency room. One of the most critical elements of success for these measures is time—are you following up or meeting expectations within the required timeframe? Tracking and acting on this will require plans to adopt cutting-edge health information technology tools that go beyond the traditional approaches.
The most effective solutions going forward will deliver a new kind of engagement, using multiple channels to offer more thorough and persistent support for members following acute clinical events. This includes capturing and exchanging real-time data between inpatient and outpatient providers to ensure members receive timely and appropriate care. To be most successful with these measures, find a solution that empowers these key activities:
- Ingests real-time ADT data
- Surfaces needed appointments to members for TRC and FMC measure compliance
- Allows users to schedule the appointment with their doctor in the same interface
The Challenge of Provider Data Interoperability
So much of Star Ratings performance is dependent on providers, especially when exploring the data exchanges with and between providers that are key for TRC/FMC/PCR measures.
But that doesn’t mean plans are powerless.
With the right performance data sorted and segmented by the attributed provider, health plans can guide providers towards the right patients and the right interventions and encourage them to prioritize activities that have the biggest impact on Stars. Plans also can learn which providers are falling short and consider incentives to engage patients, close care gaps, and improve care delivery and outcomes across all Star measures.
Deprioritizing & Reducing the Value of HEDIS Measures
For many years, HEDIS screening measures were a guiding light for MA plans. Stars teams knew that a relentless focus on clinical quality measures offered a clear mathematical path to a 4-Star Rating. With the new ascendance of CAHPS ratings, the focus has shifted away from preventive screening measures to prioritizing the consumer experience.
This shift is a result of plan performance data showing that plans have mostly mastered HEDIS screening measures. Performance is expected to maintain a level of excellence regardless of the HEDIS weightings. While plans cannot and should not abandon clinical quality, they will have to rethink how they allocate time and money today to perform well on future ratings.
There is no simple path to follow. The decline in value for HEDIS measures is a reminder that CMS will not hesitate to make big changes to Star Ratings as the agency pursues a broader goal of transforming US healthcare and plans need to be ready.
What’s Next for Star Ratings Teams?
As we learned from our webinar, nearly one in three Star Ratings managers is worried about all of the changes outlined above. Stars teams will need to adopt a nimble approach, one that is open to rapid shifts in direction. That is where an outside voice may prove especially helpful.
Consider finding a partner that can offer technology and expertise customized to match their plan’s operations. Outside guidance can help you focus not just on what to do but also on how and when to do it. A partner that knows your plan can make sure you are ready for what’s next.
Our team of Star Ratings Experts is here to help you get the results your plan is striving for. Email me for more information at email@example.com
Melissa is a well-known thought leader and healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, HEDIS scores, quality performance, health outcomes, and the member experience. As EVP of Healthmine’s advisory division, she helps clients evaluate market dynamics and opportunities, optimize distribution channels, and fulfill strategic planning needs.