In the ever-evolving world of healthcare, the importance of Star Ratings cannot be overstated. These ratings, issued by the Centers for Medicare & Medicaid Services (CMS), have a significant impact on a health plan’s reputation, member enrollment, and financial performance. However, the landscape of Star Ratings is undergoing a transformation that requires health plans to adapt and implement new strategies to maintain their competitive edge.
Now that the 2024 Medicare Star Ratings have been released and AEP is underway, let’s delve into the recent and upcoming changes in the Star Ratings program and explore strategies and best practices to mitigate risk, overcome challenges, and improve member engagement and experience.
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Understanding the Changing Star Ratings
The 2023 Star Ratings saw a fundamental shift, with an increased emphasis on patient experience and access. The CMS introduced a weight adjustment, elevating the patient experience component from a weighting value of two to four. Even though the weighting value will move back down to 2 for 2026 stars, health plans still need to focus on delivering exceptional member experiences.
Quality ratings, particularly those related to Consumer Assessment of Healthcare Providers and Systems (CAHPS®), member experience and access, are now more critical than ever. Health plans must focus on providing positive experiences to their members to maintain high scores in this domain.
One of the most significant changes on the horizon is the introduction of the Health Equity Index (HEI), along with the removal of the Reward Factor, which was previously a vital component in Star Ratings. It’s no longer enough to provide high quality care to the general population. The HEI will require health plans to pay closer attention to the healthcare experiences of vulnerable populations, including dual eligible, low-income subsidy, and disabled individuals.
There are also some new Part D measures on the horizon around concurrent use of Opioids and Benzodiazepines, polypharmacy use of multiple anticholinergic medications in older adults, as well as polypharmacy use of multiple central nervous system active medications in older adults too. So it’s important to work with your pharmacy and clinical teams to help make sure you’re getting messaging out to providers and support to members to help manage these drug classifications.
While the final rule changes will impact plans very differently, knowing how you will be impacted will determine your path forward. Why not apply each proposed change to your overall Stars 2023 and see the effect they have on your final results, assuming no performance change whatsoever. We’re sure you’ll find the results surprising, but more than that, it’ll arm you with the information you need to mitigate risk and adapt your strategies to ensure your continued success.
So, how can you impact and influence these measures across the Stars landscape moving forward?
Member Experience is Paramount
The recent changes and the introduction of the HEI emphasize the importance of member experience across the board. Now, Quality Ratings and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) ratings gauge the member’s experience and satisfaction with their healthcare providers and health plan.
Health plans should therefore view every interaction with their members as an opportunity to enhance the member experience, from appointment scheduling to care coordination. Take the time to understand not just where there’s room for improvement, but also what’s working well through the use of event-based check-ins, surveys and benefits. Implementing a three-pronged approach to behavior change that includes behavioral science, learning strategy, and a focus on health equity can help health plans drive better outcomes.
With the HEI coming into play, health plans must pay special attention to vulnerable populations. Member populations are anything but homogenous and represent a wide array of ethnic, racial and linguistic backgrounds, as well as being impacted by a variety of SDoH factors.
NCQA started adding socioeconomic stratifications to a number measures some years ago, and this trend is expected to continue. Strategies to manage these populations should include addressing barriers to care, providing transportation options, and offering culturally sensitive content and language options to improve engagement and outcomes.
The Role of Digital Engagement
Contrary to popular belief, Seniors, who make up a significant portion of Medicare beneficiaries, are increasingly receptive to digital channels, such as SMS messaging. While they might struggle with new digital technologies, 98% own a mobile phone (81% own a smartphone) and 94% use text messaging regularly. This shows that they are very comfortable with the simplicity and consistency of the text channel interface.
Interestingly, Seniors have some of the highest levels of engagement across population segments within programs. In fact, they have the highest levels of “conversational turns”. This means that when a plan sends a message, Seniors engage in the conversation and send responses back. Health plans should leverage these channels to connect and engage with senior members effectively.
The Art of Conversation
There are a number of proven strategies health plans can employ to address these changes in Star ratings measures, such as leveraging best practices across behavioral science, instructional strategy and culturally sensitive and relevant content when it comes to the streaming content.
Members should feel heard, valued and informed throughout their healthcare journey. Two-way conversations are a powerful tool in this regard. These interactions, often facilitated through SMS messaging, allow health plans to engage with members effectively.
While standard two-way interactions are unable to provide tailored responses to potential barriers members might reply with, personalized two-way conversations can identify potential barriers to care or even members who may need specific screenings. Making use of Natural Language Understanding (NLU) and AI, they’re able to respond appropriately, provide real-time assistance, and enhance the member experience. In this way, health plans are able to close the intention gap and increase motivation to take action.
Furthermore, delivering culturally sensitive streaming health content that addresses health literacy gaps in a member’s preferred language can significantly impact the outcomes of outreach campaigns, improving preventive screenings and member engagement. By offering compelling, culturally relevant content, health plans can resonate more deeply with diverse populations.
The consumer experience should be at the heart of every health plan’s strategy. By leveraging best practices, like two-way conversations, personalized messaging and streaming health content, health plans can connect and resonate with their diverse member populations, and so differentiate themselves in a crowded market.
Charting a Way Forward
The changing landscape of Star Ratings requires health plans to adapt and embrace new strategies. As the industry places more emphasis on member experience, health equity, and quality ratings, health plans must prioritize these aspects to thrive in the competitive healthcare market.
By implementing behavior change methodologies, and leveraging digital engagement, health plans can not only maintain their Star Ratings but also improve the overall health and satisfaction of your members.
