The summer months are usually a time when Star Ratings teams can relax and recover from the spring’s busy HEDIS® and CAHPS surges and re-energize before the inevitable fourth quarter press begins.
This year is different. As CAHPS measures take center stage and comprise one-third of the overall Star Ratings, now is not the time to pause.
Here are 3 of our top tips for Medicare Advantage (MA) plans to achieve Star Ratings success as we head into summer.
Hot Tip #1: Modernize Your Stars Work Plan
Just as it has with every aspect of our lives, the pandemic has substantially impacted our Star Ratings efforts. The past year of remote work, closed provider offices, and people staying home in fear of the virus have changed our members’ lives and how they navigate healthcare. But while we were locked down, we’ve seen telehealth explode, digital and remote patient monitoring become standard practice, and members begin to expect more from insurers.
For some plans, making changes to Stars work plans to be successful post-pandemic has been a challenge. In most cases, it’s safe to say: “What got you here won’t get you there.”
We know it can be hard to muster support for dramatic shifts in strategy without face-to-face dialog with colleagues, vendors, providers, and partners—and often even harder to secure budget for these shifts while colleagues are not collaborating in person. We recommend using these summer months to aggressively modernize your Stars work plans to help reduce the likelihood of getting caught by surprise when the ratings are released this fall.
Hot Tip #2: Integrate Your Data
One of the most exciting pandemic developments has been the emergence of cross-domain data strategies. Before going into lockdown last spring, many plans were still struggling to integrate their HEDIS and PDE data.
Lockdown helped our technology experts and vendor partners accelerate long-overdue data integration strategies. Now, it’s commonplace for a plan’s primary data warehouse (whether in-house or vended) to support whole-person and/or provider-centric work by integrating HEDIS, PDE, mock-CAHPS and mock-HOS data into a single source of truth. In many cases, this same warehouse also contains risk adjustment, member retention, care management, and other data points to allow even deeper precision and refinement.
We are strong supporters of using all of these data sets to optimize your Stars performance. If your data warehouse doesn’t yet have all of these data sets in a single location, we recommend making that a top priority this summer! With well-integrated data, your fourth quarter Stars press can be hyper-precise, enabling data-driven provider strategies to be deployed in Q4 and Q1 towards CAHPS and HOS measures.
Hot Tip #3: Work with Enough of the Right Members
With patient experience measures representing one-third of your overall rating, succeeding in Stars this year is going to require more than just “tiny tweaks” to old member engagement strategies. For strong CAHPS performance, use what you know about all members to find unengaged and under-engaged members. Often, the reason they are low-spend and/or non-compliant on HEDIS and PDE measures is because of “CAHPS gaps in care.”
Still, don’t forget about members who are just “OK”— those who are not terribly pleased but also not so displeased they will disenroll. These members are often far more easily influenced than highly displeased members for CAHPS improvements. Use a data-driven model of managing CAHPS to find these members and work with them during the rest of the year in support of member experience success.
In the era of post-pandemic integrated data options, we strongly recommend treating CAHPS measures just like HEDIS measures—as gaps in care with a focus on finding and closing the high-ROI gaps.
Have a Star-Filled Summer
The clock is ticking on the many changes required for success on new 2022 measures and the increased weight of CAHPS. Don’t let a relaxing summer season catch you off guard when the 2022 ratings are released this fall.
If you need help reaching your Star Ratings goals, our team of experts has deep expertise and can support your success. For more information, email me at Melissa.Smith@healthmine.com.