By Courtney Seypura
From 2022 to 2023, star ratings for Medicare Advantage Plans (MAPs) have dropped—from 68 percent of MAPs having 4 stars or higher to only 51 percent having 4 stars or higher. That means slightly less than half the plans available to Medicare eligible members have achieved a good rating.
A large cause of this drop is Centers for Medicare and Medicaid Services (CMS) placed a heavier weight on “Member Experience” when generating ratings. Patient experience and access are now at the forefront, and with it, MAPs need to ensure patient satisfaction is a priority as they prepare for the fast-approaching Medicare Annual Election Period (October 15 to December 7).
For those MAPs with lower CMS star ratings than they would like, or those with CMS star ratings they would like to maintain or boost, here are four tips for setting your organization apart, helping to increase your CMS star ratings, and making your members feel like VIPs.
- Constant Focus – Provide thoughtful, proactive, knowledgeable, and skillful member engagement tactics throughout the year, as well as during AEP. This can increase star ratings and drive better member experiences, higher preventative care engagement and chronic care management, and quicker response to member complaints.
- Control Complaints – Mitigate member complaints that tend to arise in the first few months after enrollment by positioning your plan to be more responsive to member and provider needs. For example, develop onboarding plans that take place after mailing out member materials; pick up the phone and start building that relationship; welcome members and thank them for choosing your plan; ensure members receive their materials and that information is accurate; and confirm they understand their copays and deductibles.
- Train and Hire Effectively – Having the right people with the proper training in your Customer Service Center is essential. Beyond the prerequisite skillset, they should have a positive attitude and be a self-motivated team player. It will make your team more effective and cohesive, which will help enhance member engagement and satisfaction. Also, provide ongoing training to keep up with changing regulatory requirements. This training should include the hard and soft skills needed to successfully help your members.
- Minimize Costs – Review your care and treatment costs to determine how you can mitigate or decrease these costs for your members. Also, consider incentivizing members to choose healthy habits that reduce healthcare costs. Be creative.
Health care solutions partners like Garnet Care can help your team increase your CMS star ratings. We can help prepare you for the upcoming Annual Election period, as well as support you throughout CY 2024. We also understand budget constraints and ongoing challenges, so we understand and embrace the need to do more with less! In this case, more stars with less headache and expense.
Courtney Seypura is practice lead for Garnet Care. She has more than 20 years of experience in Medicare and Medicaid operations and project management. Garnet Care helps health plans, administrators, hospitals, and providers improve patient experience and program performance through system and process optimization. Courtney can be reached by email at cseypura@garnetriver.com or by phone 518-605-0216.
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