HIT Think

Five tactics payers can use to improve their Star Ratings

Medicare’s five-star quality ratings system reflects how well a health plan meets member needs and federal recommendations on patient care. Performance ratings, which are publicly published on Medicare.gov, influence consumer perception of payers and have a direct impact on a health plan’s member enrollment, revenue and potential to earn bonus incentives.

Member enrollment. A one-star higher Star Rating has been associated with a 9.5 percent greater likelihood of member enrollment.

Revenue. For plans with a 3.5 Star Rating, improving one measure can increase revenue by $2 per member per month on average.

Quality incentives. Medicare Advantage plans that score a 4 Star Rating or above can receive a 5 percent Quality Bonus Payment.

The Centers for Medicare and Medicaid Services released the 2020 Medicare Advantage and Part D Star Ratings results on October 11, 2019. Although 2020 ratings are set, it’s not too late for health plans with room for improvement to focus efforts around key interventions to drive gains on 2021 quality metrics. Through the end of the year, plans can make one final push to close care gaps and boost 2021 performance.

CMS Headquarters

For health plans to succeed, there are a few fundamental factors to consider. To be conducive to the narrowing window of opportunity that remains, initiatives must be time-sensitive, employ the right focus and the right reach, and make intelligent use of existing resources.

Here are five strategies payers can employ to quickly and successfully boost ratings to the next Star level in the fourth-quarter push to the finish line.

Focus on the right measures
Now is the time to develop a laser-focused strategy that prioritizes a few quality objectives with the greatest potential to move the needle on ratings performance. Actionable analytics should be a key driver of program determinations. Identify quality metrics that fall just short of target thresholds and apply a fine-tuned strategy that promotes member activation related to those specific measures.

Design programs around members most likely to take action
Beyond informing which quality initiatives to target, data and analytics can help health plans predict which members are most likely to follow through on clinical recommendations based on past behavior. This allows plans to allocate resources for the most impact. Implement initiatives that will help the organization reach goals via the quickest, easiest means possible. Often times, sending a simple reminder—whether via text message, email, call or letter—can effectively encourage member participation in gap closure programs.

Rethink the member experience
Build tailored interventions that help members overcome barriers and that fit easily into their lifestyles. Digital engagement solutions and retail-based or at-home health testing programs offer members a quick and convenient way to engage and get screened for conditions like diabetes, colorectal cancer and kidney disease. Develop messaging designed to appeal to specific patient sub-sets and personas to stand a greater chance of cultivating member follow-through on meeting health objectives. Retail partners represent ideal venues, particularly during the holiday shopping season.

Support innovative provider collaboration
Healthcare providers are a key component in any effort to drive quality improvement. Motivate providers to engage in Star Ratings efforts without creating an additional burden for them. Implement programs where providers receive alerts when member screening results fall within critical ranges so they can intervene. Member outreach initiatives that are co-branded by both the health plan and the provider fare greater chances of driving desired health actions. Depending on budget, explore the feasibility of end-of-year provider incentives.

Find a strong analytics partner
Leveraging consumer analytics in omni-channel engagement strategies to promote member action in a short time span can be an overwhelming task. Seek strategic partners to help get year-end initiatives over the finish line. Engaging third-party partners with expertise in member engagement and quality improvement programs can alleviate internal staff burdens and bring dedicated focus to efforts. Lean on these partners to enhance member insight and help facilitate targeted engagement programs that can net quick results.

With the window to influence ratings closing, the time for health plans to take action is now. Plans with member enrollment, revenue and bonus earnings at stake should develop a targeted strategy that will yield maximum results in the diminishing time left to improve performance.

To quickly achieve the quality performance improvements needed to yield Star Ratings gains, health plans must leverage data and analytics to better align targeted care prompts with member preferences. By coupling data-driven engagement strategies with innovative avenues to care access, health plans can effectively motivate members to take the next steps in their care journey and successfully move the needle on quality metrics before time runs out.

For reprint and licensing requests for this article, click here.