ARTICLE
Over the last 4 cycles of the Centers for Medicare & Medicaid Services (CMS) Star Ratings program, the 4-Star cut points for Health Outcomes Survey (HOS)- and CAHPS-based measures have remained relatively stable.
Since 2017, some measures such as Improving or Maintaining Mental Health have seen a slight decline from a score of 85 to 82 to achieve 4 Stars. Unlike HEDIS® measures and medication adherence measures, these member experience measures have not seen the drastic cut point increases. Take, for example, measure C07, the Adult BMI assessment. In 2017, a score of 90 resulted in a 4-star rating. Without improvement by 2020, the same score would now result in only a 2-star rating.
CMS: Trends in Part C & D Star Rating Measure Cut Points
In evaluating the 4-year historical trends among the categories of measures, Medicare Advantage (MA) plans have increased performance in prevention and medication adherence measures. At the same time, the member experience, as indicated by cut points, has remained relatively flat. When considering this analysis, the reasoning behind weight changes for member experience measures communicated by CMS becomes more apparent. By increasing the weights and thus increasing the importance of member experience, CMS is hoping that the industry, at large, improves member experience.
Prioritizing HOS Measures
As plans start to shift their attention to the CAHPS-based measures focusing on member experience and engagement, it's important to remember HOS measures as well. While HOS might seem tangential, both surveys ultimately measure the member’s journey with a health plan.
While the weight of the HOS-based measures was not impacted in the 2021 Call Letter, the Improving or Maintaining Physical and Mental Health measures are still triple weighted. In combination with the other HOS-impacted measures, approximately 12% of the overall score is attributed to HOS results. Historically, these measures have rarely been considered a viable means of significantly improving a Star rating. The HOS has value beyond the 5 HOS measures in Medicare Part C.
Go Digital for Smarter Engagement
Research has consistently indicated that patient-reported HOS health information is tied to health outcomes and member satisfaction. The HOS can provide invaluable data on the biggest opportunities for score improvement. When leveraging a continuous year-round digital tool, plans can efficiently get a sense of their members’ health and satisfaction and quickly flag areas of improvement. Perhaps even more useful, the plan can rethink their communication with members. Rather than bulk mailing pamphlets that few members read, a digital tool can show plans the areas in which specific members need help. Plans can then perform targeted outreach on these members, with communications tailored bespoke to the needs of each member.
A digital engagement tool provides value to the member in and of itself. The member receives immediate feedback on their health based on their input. This instant result encourages the member to act by communicating with them when they are already engaged and giving them the means to learn and improve their health.