A plan’s Star score is on payers’ and members’ minds alike—especially when choosing a plan. It may sound unimportant or even trivial, but the reality is that a plan's Star rating determines how profitable and respected it is seen in the market, as it is the standard rating used by the Centers for Medicare & Medicaid Services (CMS) to evaluate and rate all Medicare Advantage (MA) plans.
This year, Star ratings fell across the payer landscape partly due to revoked COVID-19 exceptions and the member experience having a weight in the scoring for the first time. Most Star ratings still come from Healthcare Effectiveness Data and Information Set (HEDIS) measures and gap closures that are critical to differentiate MA plans in a competitive marketplace and determine the number of quality bonuses paid.
In response to the overall decline in 2023 Star ratings, based partly on the deterioration of member satisfaction and experience, many brands turn to trusted partners to seek solutions and offerings developed specifically to help payers achieve improved Star ratings, foster a positive member experience, and ultimately bolster their Medicare plan’s financial results.
In our first installment of this series, we discussed the 2023 Medicare Star scores and where they are now. In this follow-up, we dive into what specific areas can improve your rating.
Room for growth: Tips for improving ratings
Only approximately 11% of the over 500 contracts rated by CMS for 2023 achieved 5-star ratings, which means there is room for improvement for MA payers to uplevel their performance.
With 72% of enrollees in private plans belonging to plans rated 4 stars or higher, the MA consumer is becoming savvier at choosing where to spend their healthcare dollars.
By 2030, the Baby Boomer generation will have aged into the world of Medicare. With an age range expanding almost two decades (from age 65 to 84 in 2030), it will not only necessitate payers to expand their offerings to meet the expectations of this population but also utilize enhanced data analysis to perform risk stratification to focus on high-risk members, including those who have chronic conditions such as diabetes, heart disease, renal failure, arthritis, and asthma, so that they can mitigate costly medical care needs.
Using data analytics to measure outreach with medical care compliance can help payers understand and implement more effective communication and improve outcomes. A key area for compliance with the senior population relies on an integrated care management model. This provides education, transportation, telehealth, in-home testing, and other resources to improve both medication adherence and follow-through for measured and preventative screenings and care.
Focusing on HEDIS measures
Another key area payers need to focus on is HEDIS measures. These are an extensive set of measures used to determine which healthcare services are performed and if those services improve patient health conditions. More than 200 million people are enrolled in medical plans that report HEDIS measures.
HEDIS measures are based on data reported by the payer to the National Committee for Quality Assurance (NCQA). Since this is a self-reporting program, payers must ensure data integrity before reporting to HEDIS. Payers should proactively review the accuracy of their HEDIS data by completing “practice runs” and doing mid-year data reporting to capture any missing fields or inaccurate data. As the adage states, “garbage in, garbage out”—and it could not be truer for HEDIS measure reporting.
Crucial factors for choosing MA plans
HEDIS performance and CMS star ratings serve to inform consumers as they select MA coverage and are pivotal in helping differentiate plans amid a highly competitive marketplace—in addition to determining the number of quality bonuses a plan can receive.
To learn more about how to get your Star score where you need it, head to our Star score offering.