Medicare Advantage Star Ratings at Risk for 2023
As MA enrollment grows to 45% of all Medicare enrollment with projections indicating more than half in the coming years, quality bonuses are also climbing uphill. Rising stakes make planning ahead for CMS’ intended inclusion of a Health Equity Index and SDOH assessment measure imperative to maintaining Star Ratings. CMS has collected feedback on three Health Equity proposals related to Stars:
- Health Equity Report- Enhancements to stratify social risks across all measures to identify opportunities for improvement.
- Health Equity Index- An enhancement to the Part C and D Star program which is intended to look across all Star measures to summarize social risks into a single score applied to the overall rating calculation.
- Health Equity Measure- A new measure developed to monitor a plan’s performance on administering SDOH assessments.
Although the finalization of these changes is likely to take time, there is no reason MA plans should not begin analyzing their processes, data, tools, and teams now. As stand-alone arms of the organization, quality and social care-focused teams may have different workflows, but the objective of creating value and optimizing outcomes is the same. MA plans should consider the following best practices for achieving success:
- Develop a Member Experience team encompassing leadership champions and experts from various sectors of the organization including quality, care management, physicians, and customer service who will bring varied perspectives to strategy discussions.
- Consider off-season CAHPS surveys to collect valuable data and make projections. Off-season surveying provides an opportunity for plans to collect far richer data and enables analysis of demographics, organization-specific services, and provider network performance.
- Adopt a PHM solution like the ZeOmega Health Cloud to centralize data across various sources including third-party vendors, community-based partners, CMS files, and census data into actionable analytics and workflows. Through layering data sources, teams can leverage varied data sets to discover opportunities and build data-driven strategies.
- Promote organization-wide awareness of each team’s role in improving outcomes. From administrative teams to clinical staff and call center representatives, each touch point with a member is an opportunity to engage and build a positive impression.
- Develop reports and dashboards to monitor performance, identify risks, and reveal trends the organization can immediately act on. Performance should be monitored against organizational goals and reviewed often.
As we continue to see the link between quality programs and social care becoming evident through policy changes, MA plans stand to benefit from a combined approach resulting in both Star Rating success and improved population outcomes.