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Category: Quality Measures

2021 Medicare Star Ratings: What it Means for Member Engagement

Posted on by mPulse Team

The wait is over! Today 400 Medicare Advantage and 55 Part D plans received the final 2021 Star Ratings from the Centers for Medicare and Medicaid Services (CMS). This is always a milestone day for every Medicare organization. Plans who perform well receive higher quality bonus payments and rebates, and have been shown to outperform lower-rated competitors in member acquisition and retention.  

This is also a big day for mPulse as we look at the role of member experience and engagement in determining a majority of each plan’s summary rating. Even in this year’s release where CAHPS and HEDIS data is carried over from the 2020 ratings, we see how CMS changes and increasing Part D competition make a major impact on performance. So, as our team looks at the 2021 data, we are always looking at the implications for the dozens of Medicare plans we partner with and member engagement overall. 

Here are some themes that stand out to us: 

Mostly Neutral and Negative Movement for Plans 

The Medicare quality landscape got even more competitive this year, continuing a trend we’ve seen from CMS in recent years to push for more stratification between plans in ratings. While the number of 5-star plans increased by one, the overall number of plans at or above 4 stars declined by a net of 16. While the 2020 ratings saw an impressive 52% of contracts at or over 4, this year’s group will drop to 49% of MA-PD contracts. With many data sources remaining static, a lot of the negative movement plans experience will be due to cut point shifts, weighting updates, and the measures that weren’t impacted by COVID-19 changes.  

This year’s data aside, the number that jumps out the most at us today is 212. That’s the number of MA-PD contracts appearing as “too new to be measured” this time, compared with the 400 actually measured. Established plans have to prepare for these newer contracts to pursue higher ratings with intense focus, knowing that a poor start can be difficult to recover from.  

mPulse is working with both long-standing plans that are evolving their quality strategy to protect high rating, as well as newer contracts that want to compete with high–rated plans immediately. The common theme we’ve heard from both types of teams is that they know they need to do more than the standard quality improvement playbook. They’re going beyond traditional engagement channels and provider-relations-centric approaches, using partners like mPulse to differentiate member experience and activate each of their members. Today’s news will only accelerate those trends.  

CAHPS Weighting Adjustments Have an Impact 

Member experience is a major topic in Medicare and these 2021 ratings are a reminder of why. This year was supposed to be a transitional period where non-flu CAHPS measures move from 1.5x to 2x weight before eventually moving to 4x in 2022 and 2023 ratings (the measurement year of 2021, coincidentally). But since CAHPS data was carried over from last year’s ratings due to COVID, plans are in the unexpected situation of seeing the same data impact their overall rating more, with good being better and bad being worse.  

While many plans will be frustrated to see CAHPS improvement efforts not reflected today, the work they have done and strategies they put in place now will have a huge impact soon. Plans that have relied on meeting call center requirements and fielding proxy CAHPS surveys are moving towards dedicated CAHPS/HOS strategies and member engagement solutions focused on Member Experience. As we see what a 25% increase in measure weight looks like today, plans are thinking about how they can understand and improve member satisfaction next year, where the weight will increase by another 100%.  

We’re working with our partner plans to create new, conversational touchpoints with members and feed critical experience data back to the entire organization – helping them make decisions driven toward improving CAHPS and HOS scores before the next major weight jump.  

Medication Adherence Is Even More Competitive 

As expected, the measures least impacted by the COVID changes were the ones to experience the most cut point movement. These measures represent an important area of focus for plans heading into next year. The Medication Adherence measures were at the top of this list with their traditionally narrow cut points and triple weighting. These measures saw a uniform drop in average MA-PD rating of .1 to .2 stars, and the SUPD measure, 3x weighted for the first time, dropped .4 stars on average. Plans that did well in these Part D measures will be very pleased today since they faced strong headwinds this year.  

Medication Adherence is one of the key measure sets for plans that work with mPulse since so much of success depends on member action. It’s another area where intense plan competition is only going to increase as more plans look to improve adherence in their entire populations and go beyond simple refill reminders. Connecting members to initiatives like 90-day supplies and mail order pharmacy, as well as gathering data on barriers to adherence helps plans improve their measures and make better decisions about pharmacy quality strategy.  

Understanding why an individual member isn’t adherent helps us get the right resource to them immediately via mobile channels while helping build a better understanding of what we need to do to help the entire population improve. That sort of understanding is critical as plans look to deal with ever-higher cut points and even more competitors going forward.  

The 2021 ratings are going to be remembered for all of the unusual circumstances impacting them. But for all of the carried-over data, impending weight shifts, and large number of new contracts, we think they tell a consistent story. Medicare Advantage plans will continue to succeed in large part by how well they engage their members to deliver a differentiated experience and drive vital actions to improve their health. We join our MA-PD customers in looking forward to a more “normal” 2022 rating set, and are excited to deliver solutions to help them reach their organizational goals, create innovative experiences for members, and ultimately better serve the people they care for.  

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

Posted on by mPulse Team

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.

Strong Outcomes Require Strong Relationships

Posted on by mPulse Team

So much of the human experience is built around relationships. Family units, loved ones, friends, colleagues, local communities, and others we interact with on a regular basis (like the barista down the street) are the fiber of our outward experience in the world. Without relationships, we begin to function differently and suffer. The current pandemic has highlighted the negative impact of social isolation as millions of Americans feel it more acutely than ever before. Simply put, relationships are fundamental to our health and survival.

Trust goes hand-in-hand with relationships. If you think about people you trust the most, odds are you have a long-established relationship with them. They’ve demonstrated over time that they can be trusted and are reliable. Once established, trust helps us bypass a lot of analysis and consideration when given advice or taught something. We more quickly internalize and implement recommendations and processes when they come from someone we trust, which is immensely valuable. Don’t believe me? Ask your mother.

How do relationships impact quality healthcare?

Just like any other community, it’s crucial that healthcare organizations build and maintain positive relationships with their consumers. Consumers rely on trusted relationships to help them make decisions on their care. A 2017 Oliver Wyman study showed that US healthcare consumers are more likely to consult close friends and family on whether to seek healthcare treatment than they are to ask their providers. Health insurers ranked dead last. When consumers feel like they have a positive, trusting relationship with their health plan, provider(s), or other organization, the barriers to sharing information, activating them in health behaviors, seeking appropriate care, and ultimately taking any action all shrink. The strength and sentiment of the relationship between each healthcare organization and their individual consumers is a key indicator of how effectively the organization can impact each consumer’s life and quality of care. Additionally, happy consumers make a direct impact on CAHPS scores and Star ratings.

It may be no surprise that relationships take time and investment to build. You probably can’t walk up to a random stranger on the street and ask for a ride to the airport. But you probably have friends or family that would be willing to take you. In part, it’s because they know you will be there when they need you, too. You have been there before; you will be there again. So how do you create this same feeling and dependability between your organization and your consumers?

Start now. Build meaningful connections with your consumers. Build trust with your consumers. Begin that positive relationship. Ask them questions in your outreach, and listen to their answers, either through staff or with technology like Natural Language Understanding (NLU). If you feel like you already have a strong relationship with your consumers, then make sure you are nurturing that relationship. The more they trust and rely on you, the more they will heed your advice or take the action you recommend. You cannot wait until the moment you need them to do something to start engaging them because consumers don’t see their relationship with you as a series of campaigns. It needs to be an ongoing, two-way relationship to create the best health and business outcomes.

Some great examples of this challenge can be found in COVID-19 outreach. Many organizations increased the amount and type of consumer outreach to inform them about rapid changes to policies, benefits, care instructions, and a lot of other information as things rapidly changed. In some instances, consumers were confused. This type of outreach and interaction was new. It felt like it came out of nowhere. If they had a stronger relationship with the organization communicating with them, and if communication like this was more typical, they would likely be more receptive and trusting.

Takeaway: start building valuable relationships now so they are there when you need them.

mPulse prides itself on helping healthcare organizations communicate with their members with the content they need through the channels they prefer. If you would like to learn more about how we can help you connect more deeply with your consumers, please contact us.