What’s Missing from Your Tool Chest? How Health Plans Can Improve Star Ratings in Medicare Advantage

Health plans can no longer afford to take an incremental approach to quality improvement and enhanced patient satisfaction in their Medicare Advantage (MA) business – a highly competitive space in markets across the country. Star ratings and Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores both directly impact enrollment, revenue, and market position. The path to improved Star ratings demands a fundamental transformation in how health plans engage with providers and members.

Experience in implementing successful MA programs across diverse markets and populations points to a set of processes and critical best practices that distinguish high-performing plans from their competition. These strategies offer solutions for health plans who want to improve their Star ratings and achieve real competitive differentiation in their markets.

Provider and health system partnerships

The foundation for success in improving MA Star ratings is a constructive, mutually beneficial partnership between the health plan and the provider. The complexities of MA require stakeholders who move beyond the opponent posture to a collaborative one. This starts with rallying around a shared definition of success and then implementing thoughtful change management that identifies and acknowledges gaps as well as a broader set of provider pain points including administrative burden, insufficient time in the day, and burnout. An approach that understands provider expectations and needs, the required resources for daily care delivery, and their key barriers will overcome initial resistance, yield more provider-centric solutions, and support sustained adoption of new practices. Health plans can benefit from strategic partnerships with entities who can effectively bridge the health plan-provider cultural dynamics, organize the parties around common objectives, and drive new processes and workflows within and across provider organizations. 

Aligning incentives

Proper incentive alignment is a crucial element for driving improvement in MA Star ratings. Health plans need to recognize that providers are navigating many and often competing programmatic requirements across lines of business and even within the MA program itself. Engaging providers to create aligned incentives creates more buy-in for the desired improvement on quality and patient satisfaction scores. Incentive design is complicated because it needs to account for different lines of business and different expectations across health plans, which is why health plan-provider collaboratives often bring in incentive design experts to ensure effective modeling.

Patient experience focus and member-centric communication

The significant weight of CAHPS measures on MA Star ratings is rooted in the idea that how the patient experiences their care is paramount. This calls for a fierce commitment to patient-centric communications and grounding all interactions in empathy and understanding, which not only improves patient experience but drives engagement in managing chronic conditions, both of which improve Star measures.

There is a commonsense way to approach this simply by thinking about what we all want as patients – making the care experience as seamless as possible and having clear communication. If a care coordinator contacts a patient about filling their prescriptions, that care coordinator must be empowered to act if the patient is having difficulties, helping to create less friction and a better care experience.

For effective communications, there are decades of literature on what works. Whether coming from office staff or the physician, patient communications must engage patients, make them feel heard, and be presented in a manner they can understand. Having a library of materials on these techniques is important and includes communications like setting the agenda with a patient, asking about adherence in a non-judgmental way, and using teach-back techniques.

Additionally, it is important that patient facing material is designed with appropriate levels of health literacy and cultural competency, both crucial elements of effective member communications. Materials must also be accessible and relevant to the target population, considering factors like appropriate reading levels, cultural context, and preferred communications channels.

Data-driven decision making 

A robust data analytics strategy and regular assessments are another effective method to improve Star ratings. Data and information between the health plan and provider group create shared understanding of and accountability for performance improvement opportunities. One example is the continuous data tracking of patient satisfaction for CAHPS scores. While overall CAHPS scores provide important insights, drilling down to individual provider practice data through targeted patient satisfaction surveys enables more precise intervention and improvement planning. This granular approach to health plan-provider data integration can help identify specific areas for attention and allow for more targeted interventions.

Systems and infrastructure

Many providers offer MA services and care delivery that meets the Star measures, but complexities in the downstream processes including code capture in the health record, claims transmittal, and other system and infrastructure issues can prevent high-quality care from being   properly recorded. It is important to trace root causes of poorly or mis-coded data and deploy interventions to ensure that appropriate care is being reflected in quality scores and remove any technical barriers.

Tools and resources

The idea of practice transformation or facilitated cycles of quality improvement has been around for decades and many physicians have experienced versions of practice transformation with varying degrees of success. Improving physician practice processes and workflows is the bedrock of improving MA Star performance (and arguably all primary care performance), but it will fall short without new resources to drive improvement. Clinical teams that are equipped with comprehensive toolkits detailing workflows, policies, patient outreach talking points, and other tactical guidance perform better, with direct improvement of Star measures.  

Conclusion

The pathway for health plans to achieve better Star ratings performance in their MA business depends on creating an ecosystem where providers are supported with the right tools and resources, incentives are properly aligned, and the member experience remains central to all initiatives. While every market is different, these are the foundational elements enabling health plans to build more successful MA programs that deliver both improved quality metrics and enhanced member satisfaction while achieving sustainable competitive and financial advantage.

Photo: Warchi, Getty Images

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