Superior member engagement sets health plans up for Star rating success in 2024. This article shares six valuable strategies to improve member satisfaction and boost Star ratings.
By Jim Bonnette, MD, Chief Medical Officer, 86Borders
Healthcare quality assessment has evolved significantly with the advent of the Star rating system, regulated by the Centers for Medicare & Medicaid Services (CMS). The system ranks health plans on a scale of 1 to 5, where a higher rating signifies superior performance in member experience, care delivery, and administrative efficiency. Notably, organizations such as SCAN Health Plan, Blue Cross Blue Shield of Texas, and Humana have set benchmarks for excellence in 2023, as evidenced by the J.D. Power 2023 U.S. Medicare Advantage Study.
Beyond the inherent reputational value of high Star ratings, health plans are incentivized by tangible financial rewards. A 4.5 to 5 Star rating ensures plans are eligible for a 5% quality bonus adjustment and a 70% rebate from CMS. In addition, CMS offers marketing and enrollment flexibility for high-star plans.
Compare these upsides to the negative impact of receiving only 3 Stars. Lower-rated plans face severe consequences instead of benefits from CMS perks. CMS now mandates that plans scoring below 3 Stars are unable to market additional memberships until their ratings improve. This includes plans with ratings as low as 2.5 Stars, which are prohibited from accepting any new applications or expanding member services.
For example, CMS recently took punitive action against Centene when two of the company’s Medicare Advantage plans were forced to suspend enrollment and marketing because of poor Star ratings as reported by Modern Healthcare on January 8, 2024.
The bottom line for health plans is that Star ratings matter and every Star counts across all three CMS metrics: member experience, care delivery, and administrative efficiency. This article explores six valuable strategies for health plans to increase Star ratings with a specific focus on boosting member satisfaction.
Six Strategies to Improve Member Satisfaction and Boost Star Ratings
To boost Star ratings and achieve overall increases, health plans should consider the following best practices as part of their internal quality programs.
Consistency is a priority, particularly with high-risk members. Ongoing member outreach helps health plans ensure accurate member data, addresses current or emerging healthcare concerns, and enhances member satisfaction.
- Implement a Proactive and Comprehensive Engagement Model
Locating and engaging members, particularly within vulnerable and transient populations, presents a substantial challenge. Health plans commonly underestimate the time, resources, and staffing required to obtain accurate and current data on these individuals. As a result, outsourcing of member engagement is common practice across health plans.
However, plans often engage multiple outsourcing vendors, each attempting at least 16 points of contact with an individual member before marking them as unreachable. This mass-outreach approach using broad versus personalized scripts wastes time and money— and causes unnecessary member confusion.
A wiser approach is to proactively use both public and private data sources to ensure the accuracy of member information before outreach begins. The outreach process becomes much more organized, efficient, and member friendly.
Personalization across multiple outreach modalities—postcards, phone call scripts, texts, and email messages—adds another level of quality and professionalism. Meet members where they are with personalized outreach versus mass marketing.
- Prioritize Personalized Care for Enhanced Customer Satisfaction
Once members are located and engaged, turn attention to personalized care. The positive impact is monumental and often underestimated. Here are four tenets of personalized care and interactions to consider:
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Recognize that each member has unique needs and perceptions.
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Foster a trusted relationship between members and care coordinators.
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Watch Consumer Assessment of Healthcare Providers and Systems (CAHPS ®) survey data throughout the year, not just at re-enrollment time. These surveys often showcase the gaps in a plan’s outreach methods.
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Advocate for intensely personalized scripts that resonate with individual member needs.
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Implement sensitivity and care coordination training for staff to shape all member interactions.
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- Address SDOH First to Achieve Stars Second
Social determinants of health (SDOH) aren’t just another data collection box to check. They reflect real and urgent member needs that must be addressed before further attempts at health plan program optimization can be made. For example, a high-risk member has little interest in a screening mammogram when rent is due and the kitchen pantry is empty.
By addressing the bottom right of Maslow’s hierarchy of needs first, health plans build trusted relationships with their members. This involves conducting personalized SDOH screenings to identify individual needs and facilitating warm handoffs to community resources. Merely listing resources or providing phone numbers is insufficient. Health plans must establish direct conditions to resources and ensure proper follow-up to achieve a meaningful impact on SDOH and Stars.
- Close Primary Care Gaps to Support All Other Initiatives
Primary care physician (PCP) engagement is part of a comprehensive care coordination plan and is fundamental to an individual's positive health plan experience. To fully engage with members, health plans must ensure they are under the care and supervision of a connected PCP.
It is imperative to assess whether members have a PCP and the frequency of their visits. This initiative goes beyond providing a PCP address. The importance of going the extra mile is essential, including the following:
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Provide help with filling out healthcare forms, translating into the patient’s first language, and explaining terms.
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Close gaps in preventive care, offering warm handoffs and assistance with scheduling, transportation, and childcare.
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Follow up with an individual after their appointment to ensure they attended, received proper care, and understand next steps to maintain care management.
Once engaged with a PCP, other health plan priorities follow. For example, ensure preventive health interventions such as breast cancer screenings, colorectal screenings, and other care maintenance interventions are ordered and conducted.
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- Chronic Care Management Is a Valuable Piece of the Puzzle
Chronic care management is a key component of achieving higher Star ratings, and industry expertise provides nuanced strategies for success. Launch tailored programs to improve medication adherence, including new ways patients can successfully manage their medications. This may involve lifestyle changes, home delivery options, or access to technology for diabetes or blood pressure management.
By empowering patients to take ownership of their health, health plans guide them toward the self-actualization stage of their needs. Stress the importance of considering individual circumstances, such as access to refrigeration for storing insulin or the need for internet access to specialized healthcare portals.
- Commit to Year-Round Member Engagement and Satisfaction
Ensuring year-round member engagement and satisfaction is not a one-time effort. It requires a continuous commitment from health plans in order to earn more Stars. According to 86Borders CEO, Dan McDonald, “If you can engage a member, nothing else matters. But if you can’t engage a member, nothing else matters.”
Consistency is a priority, particularly with high-risk members. Ongoing member outreach helps health plans ensure accurate member data, addresses current or emerging healthcare concerns, and enhances member satisfaction.
Win Your 2024 Race for Member Satisfaction and Stars
In the pursuit of achieving higher Star ratings, health plan leadership must recognize that such initiatives require time to yield results. Superior member engagement is not a sprint. It is a marathon. Long-term strategies such as those mentioned above deliver better member satisfaction, quality outcomes, and improved Star ratings.
The need for a comprehensive, strategic, and member-focused approach to meet and exceed the standards set by the Star ratings system is more pressing than ever for health plans. By incorporating these proven strategies, health plans can navigate their 2024 quality assessment and position themselves as leaders in delivering exceptional care and service to their members.
About the Author:
Dr. Jim Bonnette, CMO, 86Borders
With over three decades of versatile healthcare experience spanning almost every sector, Dr. Jim Bonnette is a seasoned healthcare expert. In his current role as Chief Medical Officer at 86Borders, he holds a key position in the implementation of innovative member engagement and care coordination to enhance the overall healthcare of health plans’ most vulnerable members.
