2024 brought significant operational challenges for Medicare Advantage plans planning for the Health Equity Index (HEI) which will end the star ratings reward factor, increased scrutiny of in-home assessments, and the development of a strategy to address the Medicare Prescription Payment Plan (M3P) to name a few. To help plans prioritize and strategically address end-of-year priorities, Mallory Mueller, Healthmine Vice President of Population Health and Equity, shared her guidance on how to close out 2024 with strong performance.
What are health plans’ biggest challenges for the end of 2024?
Teams are focused on multiple competing and overlapping priorities across their organization during the last few months of the year, but a big area of focus is the Annual Enrollment Period, which runs from October 15 to December 7, 2024, and the months leading up to it. This is the last chance to increase member retention rates going into 2025, and any outreach attempts throughout that period will play a major role in member decisions.
At the same time, risk adjustment and quality improvement teams are reaching out to members to address open care gaps. Recent news and regulatory scrutiny about in-home assessments are bound to impact member abrasion and plan perceptions, which could put Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores at risk. Plans may be hesitant to incorporate these types of visits at the end of the year, but there are other options.
The re-release of the 2024 Star Ratings will also be on the top of Stars teams’ minds after the Centers for Medicare & Medicaid Services (CMS) was ordered to recalculate scores. In addition to the release of the 2025 Star Ratings, teams may lose focus on their 2026 Star Ratings targets, leading to a big fourth quarter push.
What can plans do now to streamline EOY efforts?
Map out all priorities across contracts and make an action plan to achieve it. There’s still time to make an impact on risk adjustment revenue, medical loss ratios (MLR), 2026 Star Ratings, the 2025 CAHPS survey and member retention.
For Stars teams, start prioritizing measures by weight and highest impact on overall rating. Coordinate with marketing, risk and sales teams to identify opportunities to consolidate messaging and address multiple issues with the same outreach. By targeting in-person and virtual Annual Wellness Visits, teams can fulfill Stars, risk, compliance and MLR needs without relying on in-home assessments.
Assessing member satisfaction now also helps teams predict disenrollment and identify ways to improve plan benefit design strategies heading into next year. Plans should focus on members who are on the fence about keeping their coverage and resolve immediate issues to bring member sentiment up. All ongoing campaigns should be shared with member-facing teams to ensure they can respond to member questions.
If teams don’t know where to start, reach out to Healthmine. Our engagement team includes experienced content strategists and behavioral scientists who can design outreach campaign calendars to keep teams on track for success.
What should plans prioritize over the next few months?
There are several Star measures that should be on everyone’s radar as we head into the fourth quarter.
Monitor new measures like kidney health evaluation for patients with diabetes closely. Members may be compliant for parts of the measure but not the entire measure, which gives plans a chance to bridge gaps in compliance and secure easy Stars wins.
The colorectal cancer screening’s hybrid component was removed in 2024, and reporting is now fully based on administrative rates. If the 2024 rate is lower than the 2023 rate’s final hybrid rate, then plans will need to ensure they have a year-round data collection strategy in place to ensure they maintain performance for this measure.
Continue implementing strategies to improve Health Equity Index (HEI) performance, such as incorporating social determinants of health (SDOH) data into outreach and targeting members with social needs. Prepare interventions to address members who need help with transportation and coordinate omnichannel outreach for members with poor digital health literacy who can only be reached by phone.
How do these last few months impact member experiences?
The next CAHPS survey is expected to begin in the first quarter of 2025 for the 2026 Star Ratings, and the period leading up to it will have a major impact on member experiences. Members will remember outreach they received at the end of 2024 when completing the survey.
Plans should ensure that messaging is consistent, relevant and helpful to members to maintain trust. Care gap closure outreach should be delivered at a member-friendly frequency to avoid coming off as too aggressive or uncoordinated. If members become confused by outreach, there’s a risk they will not take any actions and go into CAHPS season with a negative experience.
How can plans prepare for next year’s big challenges?
The Medication Prescription Payment Plan (M3P) pharmacy changes are going to be very confusing to members. Plans need to focus on educating members throughout the changes and train staff to answer questions as members navigate the new program. Teams can stay on top of these issues by using Pulse Surveys early on to measure member abrasion and the impact of these Part D changes on member experiences.
The Health Outcome Survey’s (HOS) improving and maintaining health measures will increase from single-weighted to triple-weighted measures in measurement year 2025. These are already challenging measures for health plans, but performance can be improved by assessing member data with mock-HOS and Pulse Surveys, stratifying outreach lists by responses and targeting members that may answer poorly. Healthmine can launch Pulse Surveys in six weeks and develop larger mock-HOS campaigns to help plans start evaluating health statuses.
The HEI will officially replace the reward factor in 2025. Plans should review their data to determine which members fit into the HEI population and which measures need to improve to increase scores.
Get Ahead of Fourth Quarter Challenges
The fourth quarter is key for defining which plans achieve quality bonus payments, achieving MLR targets, solidifying member retention rates and maximizing risk revenue. Tackling this list of priorities sounds overwhelming, but plans do not have to do it alone.
Through a combination of targeted survey and outreach tools, Healthmine’s member engagement and experience solutions enable teams to achieve high-priority performance targets in a short period of time. Teams can quickly evaluate member experiences through digital Pulse Surveys or cost-effective Interactive Voice Response (IVR) calls for offline members. Based on this data, plans can segment outreach lists by priorities and coordinate outbound call campaigns to close care gaps, address social needs and resolve member feedback.
End 2024 on a high note with a targeted end-of-year campaign. Contact us for a demo.
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