Medicare Advantage (MA) plans have long been accountable for quality performance, and Stars, the CMS quality assessment program, is an important measure. CMS Star Ratings help MA plans attract members and earn financial incentives. Plans with higher Star Ratings are associated with better health outcomes, improved customer service, and more comprehensive benefits.
CMS recently made game-changing updates to its methodology for calculating MA quality scores to prioritize member satisfaction. Beginning this year, customer-experience-related metrics will determine 57% of overall Stars ratings. With more than $10 billion in Stars-linked incentives, outstanding customer experiences are more important than ever.
What are MA Star Ratings?
Star Ratings help people compare and choose the best plan for their needs. CMS rewards plans for high-quality care, and encourages lower-rated plans to focus on quality improvement. The financial bonuses for high-performing plans can be significant and contribute to the overall financial stability and success of the health plan.
Progressive organizations are re-imagining how they work with providers to make it easier to unlock great experiences for members.
Star Ratings range from 1 to 5 stars, with 5 stars representing the highest quality. Plans are rated on an annual basis, and the ratings are updated each fall, usually in October. Star Ratings are made publicly available on the Medicare Plan Finder website and other CMS resources.
How Do MA Star Ratings Work?
CMS evaluates MA plans based on a set of quality measures, including preventive care, management of chronic conditions, customer service, member satisfaction, and overall member experience.
MA plans are assessed using data collected from various sources, including surveys of plan beneficiaries, medical claims, and administrative data submitted by the plans.
CMS uses Star Ratings as a basis for awarding bonuses to high-performing plans. These bonuses provide financial incentives for plans to improve their performance and enhance the quality of care they offer to beneficiaries.
High-rated plans (those with 4 or 5 stars) may receive special benefits, such as a continuous Special Enrollment Period. This means that beneficiaries can switch to a 4- or 5-star rated MA plan outside of the regular enrollment periods.
MA Plans are Booming:
How Will You Stay Competitive?
Download our report “Home Benefits Surge in Popularity Among Medicare Advantage Plans” to learn more about leveraging supplemental benefits to increase member satisfaction, retention and STARs.
3 Strategies to Improve Member Experiences
Anne Tumlinson, CEO of ATI Advisory, said progressive organizations are spending time re-imagining how they work with providers and organizations that they contract with to make it easier to unlock great experiences. She shared three strategies to improve member engagement and satisfaction.
- Reduce the friction around payment. Creating a debit card, or sending members a points card that they can use when they’re working with in-network providers, puts the consumer in charge.
- Make everything as flexible as possible, potentially offering access to services like food, in-home support services, or non-medical transportation in different kinds of combinations and packages.
- Lastly, she said there’s no substitute for the ability to easily contact a live person for support if there are questions about the services being activated and delivered.
What’s Next for MA Members?
People have choices when it comes to what kind of healthcare they want, how and where they access it, and which insurance plan is the best fit. In response, plans are becoming innovative in how they unlock new benefits to boost satisfaction and help people live their very best life.