December 7 is the deadline for membership enrollment into Medicare Advantage (MA) plans. Star Ratings for MA plans were recently released, and it’s a safe bet that members will be shopping for plans that performed well. But while picking an MA plan might seem as simple as looking at cost and Star Ratings for potential members, health plans know that quality and deliverability are more complex. Health plan leaders need to think about changes in the MA landscape as the deadline for enrollment approaches and health plans welcome new members:
1. Member satisfaction is more important than ever.
CMS’s most recent Star Rating system places greater importance on customer experience. While health plans have always known that customer satisfaction is important, Star Ratings are actually changing so that member experience carries more weight, and that weight will increase over time. The 16 measures that fall into CMS’s “Patient experience and complaint measures” and “Measures capturing access” will increase in weight from 1.5 this year to 4 in 2023. Health plans will need to make member satisfaction a top priority in the coming years and ensure they have the best tools to develop lasting member relationships and loyalty.
2. Many popular plans have decreased in Star Ratings, so loyalty may be at risk.
Because fewer MA plans achieved a 4 Star Rating for 2021, members may notice a decrease in the Star Rating for the plans they’re enrolled in. While many plans are increasing efforts in chronic disease management benefits and offering additional telehealth benefits, those expansions haven’t been enough to maintain high Star Ratings. Health plans should invest in ways to stay ahead of changes to Star Ratings and ensure their reporting data quality is sufficient to support them in their efforts to achieve and maintain the best possible Star Ratings.
3. Even if plans maintain enrollment, bonus dollars could be at risk.
While member retention may waver based on a decrease in Star Ratings, even if health plans can keep enrollments high, they may still be at risk for decreased bonus dollars. Because reimbursements are tied to retention and Star Ratings, efforts to keep members may not be enough. Health plans can arm themselves by embracing CMS’s focus on member satisfaction (both for ratings and retention), focusing marketing efforts on commercial plan enrollees as they age into Medicare, and ensuring peak data quality so they have a clear picture of their member populations and can report successes and identify potential opportunities for Star Rating improvement.
As payers navigate the changes and the new focus on member satisfaction, clean and complete data is of paramount importance. Digital quality measures materially impact provider-member relationships and help payers provide complete and accurate reporting to obtain the highest quality and satisfaction ratings.
If your organization has questions about obtaining the best quality clinical data possible, reach out to our team. We’re always happy to discuss ways to get the most from your data. We’re even offering a risk-free Medicare Advantage Data Gap Assessment. Click here to learn more.