Star Ratings: Your Work This Year Will Have Lasting Consequences

June 16, 2020 Anne Davis

For the past few months, COVID-19 has disrupted virtually every aspect of life in the United States. The healthcare sector has, of course, been among the hardest hit. In pandemic “hot spots,” hospitals and health systems have struggled to keep pace with patient needs. Across the country, providers have changed their operations for seeing patients, many appointments have been rescheduled or cancelled, while other offices are “opening up” for non-essential services. Patients are wary of visiting the hospital or their providers’ office, and many have abandoned medical visits to manage chronic conditions. Preventive care like wellness checks, routine screenings and immunizations have fallen by the wayside.

COVID-19’s Impact on Medicare Advantage Star Ratings

Medicare Advantage Star Ratings are based on plan performance in five categories:

  1. Screenings, tests and immunizations to keep people healthy
  2. Management of chronic health conditions
  3. Plan responsiveness and care
  4. Member dissatisfaction, trouble accessing service and plan abandonment
  5. Plan customer service

Given the stresses that the healthcare sector has experienced with the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) decided to change the way it calculates star ratings for Medicare Advantage (MA) plans this year:

  • CMS will stop the data collection surveys that would have been used to calculate the 2021 MA star ratings. These include the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and gathering Healthcare Effectiveness Data and Information Set (HEDIS) results.
  • Instead, the 2021 star ratings for a Medicare Advantage plan will be based on the plan’s 2020 scores.

The intent of these changes was to reduce the administrative burden for Medicare Advantage plans and providers. For some plans and providers, this is good news. For others, it is disappointing.   At this point in time, CMS indicates that next year’s data collection will go as planned, quality improvement efforts are cumulative and our work in 2020 (for 2022 Star Ratings) matters.

What Can Medicare Advantage Plans Do?

If we use the lens of this year to look at the five components of MA star ratings, it’s clear that closing healthcare gaps this year will be challenging at best. Due to the COVID-19 shutdown, most plan members haven’t kept current with their screenings, tests or immunizations. In addition, many members with chronic conditions have avoided regular appointments, and with CMS recommending that unless conditions warrant in-person healthcare, those with an elevated risk for contracting COVID-19 should continue to shelter in place.

This means that MA plans must focus extra attention this year on plan responsiveness, the member experience and member satisfaction. There’s no time to lose. J.D. Powers’ 2020 U.S. Commercial Member Health Plan Study, which was conducted between January and March of this year, found that consumer satisfaction with health plan engagement was far from outstanding. Concerning insights include:

  • Only one third of members (36%) indicated their health plan acts in their best interest “always” or “most of the time.”
  • Just one quarter of members view their health plan as a trusted partner in their health and wellness.
  • Around half (48%) said their health plan hasn’t shown concern for their health since the COVID-19 pandemic began and over half (60%) indicated that their health plan didn’t contact them with guidance or information related to the coronavirus.

The nation’s re-opening presents an ideal opportunity for Medicare Advantage plans to re-engage with members. HMS’ Eliza solution enables plans to develop outreach campaigns and contact members via text message, email, automated phone call or live agent. This is a good time to provide information on topics like:

  • How to schedule preventive care visits or appointments for chronic health conditions. Plans may want to provide information about telemedicine or virtual visits for those who may still be reluctant to come into their provider’s office.
  • How providers are making their offices safe for patients, such as frequent sanitizing of facilities and limiting the number of people in waiting rooms, as well as staff and patient protocols related to masks and personal protective equipment.
  • Additional benefits that the MA plan offers to members, such as incentive programs, behavioral health support and fitness discounts that can be utilized during this unprecedented time.

Medicare Advantage plans may want to implement consumer satisfaction surveys. While it remains unclear as to the timing of the Health Outcomes Survey this year, CMS indicates that the CAHPS survey will be delivered next spring as scheduled. Off-cycle surveys are a helpful way to take the pulse of members and address areas that need attention. HMS works with plans to develop and deploy customized question sets.

In this day and age, the only certain thing about the future is uncertainty. It’s unclear whether there will be a second wave of COVID-19 and if there is, will it coincide with flu season? Time will tell. CMS regulations and guidance are also likely to evolve. Despite the ambiguity that we all face, Medicare Advantage plans can take proactive steps now remind members that their plan is available to them for support and information. Plans can take this opportunity to improve the member experience and boost satisfaction levels. This work is sure to pay dividends in the months ahead.

About the Author

Anne Davis

Anne Davis is the Director of Quality Programs & Medicare Strategy at HMS where she focuses on the company's Population Health Management product portfolio. Anne has spent the last 20 years focusing on healthcare quality, care and evaluation. Prior to joining HMS, Anne was responsible for care management, utilization review, and population management at a five-star Medicare Advantage plan and integrated delivery system. Since 2015, Anne has worked as a consultant, focused on HEDIS and Stars, quality programming, and reporting & evaluation. When she isn’t working, you’ll find Anne at the beach with her family, teaching yoga classes and hiking in her beautiful home state of Maine.

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