In an era when Medicare Advantage (MA) Star Ratings are in decline, health enterprises and providers must implement new digital strategies that can help them elevate operations to maintain their competitive advantage and keep pace with today’s sophisticated consumers. The MA Star Ratings system has long been a cornerstone in assessing the quality and performance of health plans, and a powerful performance is crucial to a plan’s sustainability. With more than 47% of the Medicare-eligible population enrolled in an MA plan, it is an increasingly important source of revenue for health systems and providers, and – because their MA payments are tied to their scores — a drop in their star ratings can impact millions of dollars in revenues.
With the Centers for Medicare & Medicaid Services (CMS) releasing annual changes that impact all facets of the program, it’s essential for health systems and providers to stay ahead of these changes and navigate them effectively by leveraging technology that can guide and optimize the complete patient journey.
Effective, streamlined digital engagement is pivotal for achieving this goal in an operationally efficient way. Leveraging digital engagement to drive up conversion through personalized content grounded in health communications across a series of nudges can improve preventive screenings, care management enrollment and activation, patient-reported outcome response rate, and help to overcome barriers to care – all of which can positively impact Star Ratings.
Identifying measures for improvement through better member engagement
The CMS relies heavily on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey in scoring, with CAHPS scores now accounting for nearly a third of the overall Star Ratings score. Therefore, to achieve higher star ratings, providers and health systems must understand which CAHPS measures to target for maximum impact.
Data-driven approaches to deliver personalized content to all patients will motivate them to complete necessary care, and it will help to remove friction from the patient activation process. That includes understanding and addressing barriers to care as well as helping to schedule referrals or engage in supplemental services like care management to ease their burden and improve their outcomes.
In addition, a growing focus in the healthcare industry has been on engaging traditionally underserved and hard-to-reach populations, such as minority communities and low-income beneficiaries. As a result, measures that assess the quality of care and the experience of these populations have gained prominence. To enhance Star Ratings, health systems should prioritize these underrepresented communities and customize their engagement strategies to meet their unique needs.
Key measures that can be influenced through better member engagement include:
- Preventive Care: Encouraging patients to receive recommended preventive care, such as vaccinations, screenings, and annual check-ups, is crucial. A nationally representative survey found that many — one in four — simply skip regular checkups because they are feeling healthy. Providers need to understand their demographics to meet these patients where they are, so they can support them with culturally competent communications that they are more likely to respond to, thereby driving improvements in quality. This level of digital engagement requires enterprises to reach beyond their electronic medical record service provider offerings to leverage new and comprehensive technology platforms.
- Cancer screenings: Timely cancer screenings can make a life-saving difference. Providers can focus on increasing participation in cancer screening programs, particularly for high-risk individuals or targeting larger at-risk patient populations. This year, the American Cancer Society research revealed that millions of people in the U.S. continued to miss critical cancer screening tests during the second year of the Covid-19 pandemic, stressing the need to improve access to cancer screenings. Reaching and encouraging patients to get essential screenings through personalized digital outreach is more effective than traditional methods of (limited-reach) portal prompts and direct mail, so adopting comprehensive digital engagement strategies can help foster meaningful engagement that can lead to substantially improved screening rates.
- Medication adherence: Non-adherence to prescribed medications remains a pervasive issue in healthcare. Research has proven that patients don’t take their medications as prescribed about half the time. Through personalized reminders to refill prescriptions, educational materials to answer common questions, and enrollment in medication management programs, health plans can significantly improve medication adherence rates among their members.
- Chronic condition management outreach: For members with chronic conditions — which impacts six in ten U.S. adults, making chronic disease the leading cause of death and disability according to the CDC — continuous care and support are lifesaving. Proactive outreach and personalized care plans to reach beneficiaries in urban and rural communities can enhance the management of chronic conditions and boost Star Ratings.
- Health equity: With the CMS adding health equity as a performance measurement beginning in 2024 that will impact ratings in the Star year 2027, providers must become more aggressive in identifying and proactively addressing the underlying social, structural and societal drivers of health. They need to more deeply understand existing barriers to care, and then surface resources to patients when they need them most. Implementing a digital patient engagement strategy can help providers reach patients how and when they like to be contacted, creating better connections between patients and providers.
Adopt new engagement strategies to deliver deeply personalized experiences and drive quality
To effectively influence these measures and improve Star Ratings, health systems must implement digital member engagement strategies that deliver deeply personalized healthcare experiences. Today’s healthcare consumers seek more than just chronic condition management and care coordination; they desire a seamless and personalized healthcare journey in the palm of their hand. Health enterprises should not treat patient engagement as a peripheral project but rather as an organization-wide initiative.
Instead of employing disparate solutions for different phases of a member’s care journey, health systems should consider investing in an enterprise-level engagement solution that consolidates what those point solutions aim to address. This digital approach creates a unified experience for members, avoiding confusion, building trust with consistent messaging under the plan’s brand, and delivering optimal outcomes. Among the features and benefits of advanced enterprise-level engagement solutions are:
- Orchestrating the patient experience: Effective healthcare communication must be a cohesive, defragmented, and patient-oriented experience. The key is the proper orchestration of the global experience, including prioritizing what to send and when to send it to optimize overall outcomes. Too much engagement can be counterproductive, as it can lead to patient fatigue and disengagement. Providers must find a level that is right for each individual patient, and that means ensuring that the outreach is based on a holistic view of the individual and their preferences. This unified view of the patient eliminates the possibility of them being repeatedly pinged to remind them about checking their blood sugar, followed by another message asking for a payment, then another to schedule a referral, etc.
- One-to-one personalization: In the past, it was difficult to capture and analyze information to personalize the healthcare experience of an individual. Today, new patient engagement technologies are enabling organizations to collect and connect a wide array of data and, applying psychographics and other scientific methodologies, develop meaningful findings from it – giving them the ability to tailor communications to their members’ unique needs and preferences. These hyper-personalization capabilities pay significant dividends; a BCG study conducted last year found that payers that implemented personalization saw customer experience improve by 10%, administrative costs drop by 5%-10% and quality standards increase by 20%-25% in a year or less.
- Continuous support: Successful patient engagement requires easing access and augmenting in-person clinic visits with proactive digital communication to effectively build trust throughout the patient journey – for example, communicating with them immediately post-discharge from an emergency department visit, or before they are overdue for an annual wellness check. Digital engagement platforms can help plans reach out to patients during moments that matter.
- Cultural awareness: Understanding patients’ beliefs, practices, cultural and linguistic needs can lead to better care coordination and better member engagement. An engagement platform that personalizes content based on members’ linguistic preferences, and can drive members to translation resources as needed, is critical to serving all populations.
Ensure ongoing improvement with hyper-personalized surveys
Measuring member satisfaction is vital for Star Ratings, and personalized digital surveys are an effective way to achieve this. These surveys are not only cost-effective but also provide instant feedback as they can be delivered via SMS messages or email, enabling health enterprises to make timely operational improvements. The hyper-personalized approach increases survey response rates and enhances data quality. The benefits of these surveys include:
- Response rates: Traditional, generic surveys often have response rates below 30%. However, personalized digital surveys can boost response rates significantly, improving data collection.
- Data quality: The data gathered from digital surveys tend to be more accurate and insightful. Members are more likely to provide honest feedback when they feel their opinions are valued and understood.
- Rapid feedback: The instant nature of digital surveys allows health plans to address issues promptly. Timely resolutions can improve member satisfaction and positively impact Star Ratings.
- Cost-efficiency: Digital surveys are cost-effective, saving health plans time and resources compared to traditional paper surveys. This efficiency allows for more frequent surveying and better monitoring of member experiences.
Conclusion
The transformation of healthcare engagement is essential not only for improved Star Ratings but also, more importantly, for the well-being of Medicare Advantage beneficiaries. Embracing technology in the most operationally efficient way, fostering trust, and providing personalized care are the cornerstones of this transformation, ensuring that members receive the quality care they deserve.
Photo: Warchi, Getty Images
