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3 Key Points: Member Engagement and the 2021 Medicare Star Ratings

October is, in many ways the month for Medicare Advantage plans. The Annual Election Period begins on the 15th, following the release of final Star Ratings early in the month to help members make informed decisions on staying or switching plans. This year’s set of Star Ratings will be different than any previous iteration. The adjustments from CMS in the wake of COVID-19, combined with the previously-announced changes to measure weighting for future measurement years, creates a unique moment for plans looking to maintain strong ratings and improve in key areas. As the leader in Medicare member engagement, mPulse has some key points to keep in mind from a member engagement perspective as we look forward to the 2021 ratings release this month.

1. Many measures dependent on engagement will not reflect change… this year

The CMS decision in March to carry over 2020 Stars for many measures means that a large portion of this month’s final release will not bring a lot of surprises. Key measures that depend on members taking action to improve their health – such as the HEDIS gaps in care measures – are traditionally critical area for quality team efforts. Those efforts back in the 2018 measurement year won’t be reflected this year. Plans already understand that what CMS chooses to do for the 2022 ratings (and possibly 2023) may have big impacts on the numbers and are preparing for volatility.

The immediate impact for member engagement is that plans won’t have a more recent benchmark against their competitors’ gaps in care efforts for at least another 12 months and that the next release may see broad swings in these measures. So the work that plans do right now to reach and activate more members around preventive care will be crucial to competing in a very different Stars landscape going forward. Plans can’t afford to wait for CMS to announce how the measurement year 2020 and 2021 HEDIS data will used. No matter what, the plans that have scaled and robust solutions to drive screening completions and better preventive care outcomes will be best positioned going forward.

2. The measures that did change will make key Part D measures even more competitive

We know from plan previews that the 2021 measures unaffected by the COVID-19 changes saw significant movement, especially in Part D. Medication adherence measures particularly saw higher cutpoint movement – and many plans will be negatively impacted by the combination of the “frozen” Part C measures and these more competitive Part D ones. There is reason to think that the Part D measures – which have long been highly clustered and competitive – will maintain these high cutpoints going forward. This means that plans must find ways to reach more and more of their population in order to improve or maintain good ratings. The traditional model of thinking – some members will always maintain adherence, some will never have a chance, and a narrow percent are on the borderline and should be the focus of engagement – has to change.

At mPulse, our Part-D solutions are typically focused on improving adherence among non-adherent or borderline non-adherent members, to try and expand the pool of members who can become adherent and join the numerators of the adherence measures. Our plan partners prefer this approach because our automation and ability to have conversational interactions on high-reach channels means they can keep their teams focused on the QI activities where human-to-human interaction is required. They work with us because we have been shown to reach more of those “denominator-only” members that traditionally don’t act on basic Rx refill reminders. That approach, whether with a technology partner like mPulse or not, is vital to success in these increasingly competitive measures.

3. The 4x weighting of CAHPS measures looms large

Perhaps the biggest topic for Star Ratings this month is the one that isn’t going to show up in the release this month. The 2020 measurement year will be the last one that will not have CAHPS and member experience measures comprising a majority of the summary ratings for the foreseeable future. Member experience moves from a 1.5x weight to 2x in the 2021 ratings, which means that older non-flu CAHPS data will play a stronger role in summary ratings – but the 2021 measurement year’s doubling of that will begin a new era for Medicare quality.

Plans are already doing the weighting math to see how their summary ratings would have changed if the 2023 methodology was used this past year, and many will need to adjust their strategies to fit what will change in measurement year 2021. The focus on member experience in stars demands dedicated strategies to build and improve relationships between plans and members – mPulse is working with plans to deploy innovative and scalable solutions that gather insights on member satisfaction and experience and create meaningful touchpoints to connect with members. Our CAHPS solution is the leading option for plans that are looking to understand and improve their relationships with members.


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