HEDIS®-based measures have long been the focal point of the Star Rating Program for Medicare Advantage (MA) plans. Even as the Centers for Medicare & Medicaid Services (CMS) made changes to the program, there remained a consistent correlation between strong performance in HEDIS®-based measures and a 4-Star Rating.
For many plans, the strategy to improve HEDIS® performance was through multiple campaigns and member touches. In recent years, plans have transitioned to consolidated communications to address all HEDIS® gaps for a member. The underlying approach, even in a consolidated communication plan, remains campaign based.
Impactful Changes on the Horizon
While campaign-based strategies often work to improve performance on HEDIS®-based measures, this strategy is less likely to be effective in addressing the overall member experience—and the tables are set to turn.
Due to the COVID-19 pandemic, CMS announced that previous CAHPS results would be included in the 2021 Star rating, which means most plans are operating with member satisfaction data from two years ago.
Many plans will be making critical strategic decisions based on antiquated data that is no longer applicable or relevant to their current population. Beyond that, CMS has made it clear in the 2021 rules changes that member experience measures are moving to a 4x weight. This weight change will give CAHPS-based measures a stronghold on a significant percentage of the Stars Ratings program. CMS expects that this change will reduce the overall number of plans earning 4 or more Stars.
With these impending changes, it is critical that plans collect member satisfaction through a well-constructed mock CAHPS survey. This data will provide plans with a line of sight into prospective areas of improvement for member experience moving forward. CAHPS has replaced HEDIS® as the focal point of the Stars Program, and swift strategic action will allow plans to implement initiatives to improve the member experience for the 2021 plan year.
What's Next for MA Plans
The solution to taking these upcoming changes in stride will be by planning now for CAHPS-based interventions and focusing on member experience. The traditional approach to gleaning insight into CAHPS performance is through a mock CAHPS survey distributed through physical mailings and phone calls. These approaches provide limited scalability due to the high cost and inefficiency. Digital surveys offer a scalable, efficient, and relevant solution.
These surveys are distributed through digital communications and can be developed so that irrelevant questions are suppressed based on member responses, which improves member experience. Further, digital surveys yield results in real-time, which allows plans to quickly receive data for a larger proportion of their membership than with a physical survey process.