Improve Star Ratings with Strong and Strategic Provider Relationships


Value-based care (VBC) programs centered around Healthcare Effectiveness Data and Information Set (HEDIS) measures are fairly standard because so many measures are directly tied to providers closing care gaps through preventive screenings or management of chronic conditions. However, simply managing conditions is not going to be enough going forward to achieve Star Ratings success. Health plans need to align more closely with their provider networks to build better member engagement practices that support whole-person care and are responsive to measure changes.

Here's how your Medicare Advantage plan can better partner with provider systems for quick measure improvement, track data in real time, and improve the member experience.

Work Closer with Providers

Health plans are struggling to keep up with the daily operations needed to run successful Star Ratings and quality programs. We’re seeing more health plans shift risk to provider systems since the number of Stars measures providers influence continues to grow. For this approach to be successful, health plans must modernize value-based contracts for measurement year (MY) 2024 and start discussions with the provider teams responsible for the annual updates and negotiations. It’s imperative that quality leaders educate provider-facing teams on the upcoming measure changes, timelines and the burden the conversion to digital measures will have on providers’ systems. Just like health plans, providers need a runway of time to prepare for changes needed for contracts, medical record enhancements, reports, workflows and compensation structures.

Tip: Align VBC programs with risk adjustment programs to streamline communications and tactics to improve care with both providers and members.

How Providers Influence Critical Measures

So much of the members’ experience with their health care begins and ends with their interactions with doctors, both primary care providers and specialists, having a direct impact on Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS) measures. These measures must be a requirement in VBC contracts going forward. Plans should provide monthly reporting to providers on performance assessed through Pulse Surveys, mock-CAHPS and HOS surveys with action plans for improvement when targets are not met.

Leverage Office Staff for Measure Completion

It’s also critical to understand that solid performance in VBC goes well beyond the front-line provider. The staff interacting and communicating with members before, during and after an office visit all influence how a member will rate the experience and in a survey. Do not overlook this very influential group. You need their buy-in to quickly increase CAHPS scores. Furthermore, digital member communications and ‘nudges’ led to better compliance and higher satisfaction with the patient experience and is well worth the investment for both the provider and plan.

Build a Relevant, Motivating VBC Contract

Innovative plans are getting creative in the structure of the VBC contracts. There is more adoption of downside risk with an overall Star Rating gate, direct payment for clean and accurate supplemental data feeds, requirements for electronic medical record (EMR) integrations and participation in quality improvement and population health programs. There is no one-size-fits-all VBC program and plans need to tweak annually to adjust for market trends, risk-tolerance and Star program changes. Ensure your program is data driven and providers have access to data as close to real time as possible. Include comprehensive reporting packages to manage their performance. Furthermore, the incentives must be worth it and be aligned with the health plan, health system and provider goal. Finally, celebrate success and publicly acknowledge the well-performing health systems and role in delivering high quality care and service to your members.

Tip: Double down on measures through digital reminders to the members right before a scheduled appointment. Paper checklists health plans provide members to take to their provider to guide appointments will no longer be enough. Either through a text or your health plan app, send a downloadable digital checklist with the relevant HOS, CAHPS, HEDIS, Pharmacy Quality Alliance (PQA) measures and other important topics the member needs to discuss with their doctor. Thank them after the visit and ask about their experience to collect real-time feedback on their experience.

If you need any assistance in developing or modernizing your VBC program, reach out to Healthmine. We design and implement VBC and member engagement strategies of all shapes and sizes across the risk spectrum and can support your plan in navigating the nuances of your member population. Contact me at to get started.

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