Your Guide for Improving Medicare Advantage 5-Star Ratings

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Starting in 2023, patient satisfaction will begin playing a much more significant role in Medicare Advantage Star Ratings by encouraging healthcare providers to place an increased emphasis on improving member satisfaction. One method of achieving this is through improved screening programs, which increases member satisfaction by increasing the probability of catching life-limiting or quality-reducing conditions while also saving money.

What Do High Medicare Advantage Star Ratings Do for A Business?

Medicare Advantage is an attractive market for healthcare payers due to the increased enrollment offered. More than 26 million Medicare beneficiaries enrolled in a Medicare Advantage plan in 2021, and the number of people covered by Medicare Advantage plans is expected to reach 34 million by 2023.

 

Because of the ability to entice beneficiaries to a company’s plan, high Medicare Advantage Star Ratings strengthen the financial performance of an organization.

 

Starting in 2023, the satisfaction metrics of Medicare Advantage members will play a much more significant role in overall Medicare Advantage Star Ratings compared to past years. In fact, they will constitute the largest portion of the overall Medicare Advantage Star Rating, accounting for 57% of an individual health contract’s rating.

 

A key factor of member satisfaction is the total experience, which should deliver clear, helpful, and proactive communication to the members. This can be accomplished through different methods and multiple touchpoints. Taking in the various factors that affect each member and their ability to seek care allows for better care that resonates with members on a personal level.

 

In addition to the benefit that high member satisfaction offers regarding your rating, having high-value, empathetic, and anticipatory services and offerings in your health plans improves the NPS score of your business, further improving financial performance.

Preventable Diseases: A Strain on Members, Payers, and Providers

One area that deserves extra attention in terms of improving member care is preventable diseases with diabetic retinopathy – currently the leading cause of preventable vision impairment and blindness.

 

About one-third of those with diabetes develop diabetic retinopathy, and it is easily preventable through early detection and treatment from screening. The key, though, is screening at-risk individuals to catch diabetic retinopathy before it has progressed too far, and this same goal can help catch other preventable diseases while still in the early stages.

 

The economic impact of vision impairment, blindness, and other disabilities caused by diseases on both patient and provider cannot be overstated. Their appearance drains health and social care resources while also impacting economic productivity.

The Impact of Preventable Diseases

More than decreasing member health and satisfaction, both payers and providers/PCPs take an economic hit from the progression of diabetic retinopathy and other preventable diseases.

 

Payers lose revenue from CMS, which provides a financial reward for completing CMS screening targets. Additionally, if members do develop the disease without detection and treatment, the payers have an increase in costs due to more extensive treatments.

 

On the Provider/PCP scale, they can lose revenue through screening claims while also losing revenue from not improving PCP QIP (pay-for-performance program).

 

Incentives are offered through the Center for Medicaid and Medicare Services (CMS) to insurance companies for meeting screening targets under the HEDIS program. However, the campaigns are often not adequately resourced or organized systematically as a screening pathway. Because of this, many people are living with permanent conditions, such as vision impairment or blindness, that could have been prevented.

What Does Constellation4 Offer You?

Constellation4 has created a campaign management platform that HEDIS Quality Managers can use to meet their annual CMS HEDIS targets and screen patients, locations, and resources. It includes all necessary capabilities to run and manage the campaign.

 

It contains five steps: identification, invitation & information, testing & reach out, scorecard, and continuous improvement. Below we have highlighted the key aspects of each step.

Step 1: Identification
Step 1: Identification

With Constellation4, you can identify and rank the population and PCPs eligible for screening based on geographic area or zip code. You can also identify and rank places where you can set up mobile screening units.

With Constellation4, you can identify and rank the population and PCPs eligible for screening based on geographic area or zip code. You can also identify and rank places where you can set up mobile screening units.

Step 2: Invitation & Information
Step 2: Invitation & Information

With this step, you can contact patients to check their availability and schedule appointments. You can also run a campaign to educate about the importance of screening.

With this step, you can contact patients to check their availability and schedule appointments. You can also run a campaign to educate about the importance of screening.

Step 3: Testing & Reach Out
Step 3: Testing & Reach Out

Group your patients based on their availability, location, and responses while also deciding which sites are best for the mobile screening unit. Referral management allows you to scale your campaign and find the right resources. Additionally, this step involves the process of testing for the disease or condition at the chosen location, which can include the doctors’ offline, mobile clinic, or in the patient’s home.

Group your patients based on their availability, location, and responses while also deciding which sites are best for the mobile screening unit. Referral management allows you to scale your campaign and find the right resources. Additionally, this step involves the process of testing for the disease or condition at the chosen location, which can include the doctors’ offline, mobile clinic, or in the patient’s home.

Step 4: Scorecard
Step 4: Scorecard

Patients who screen positive for the disease or condition can be referred for further evaluation, diagnosis, or treatment. Additionally, those who screened negative can be reported and kept for future campaigns.

 

With the campaign management platform, you can also identify patients with unreported claims and eligible providers/PCP visits without the reported screening.

 

Finally, continue to track actual vs. target data to improve upon the campaign.

Patients who screen positive for the disease or condition can be referred for further evaluation, diagnosis, or treatment. Additionally, those who screened negative can be reported and kept for future campaigns.

 

With the campaign management platform, you can also identify patients with unreported claims and eligible providers/PCP visits without the reported screening.

 

Finally, continue to track actual vs. target data to improve upon the campaign.

Step 5: Continuous Improvement
Step 5: Continuous Improvement

The goal of the campaign system is to continuously improve the effectiveness and cost management of the screening program, which is achieved as it continues to collect, analyze, and report on outcomes.

The goal of the campaign system is to continuously improve the effectiveness and cost management of the screening program, which is achieved as it continues to collect, analyze, and report on outcomes.

How Constellation4 Health Improves Medicare Advantage 5-Star Ratings

Investing in member-centric tools that boost member satisfaction will not only increase your 2022 bottom line but will also place your organization in a favorable position come the 2023 year for open enrollment and beyond.

Diabetic retinopathy is just one example of a condition diminishing patient quality of life that can be prevented and delayed from progression if caught early. With the increased focus on patient satisfaction for Medicare Advantage Star Ratings, it is clear that finding ways to improve patient satisfaction and retain access to this extensive market should be a high priority for all companies.

Constellation4 Health offers a solution, a campaign management platform that allows for increased and improved screening on patients and testing locations, creating an effective screening system for preventable diseases that saves money and increases member satisfaction.

If you are interested in learning how this platform can help you organize campaigns and beat your screening targets, email us at info@constellation4.com or go to www.constellation4.com/contact-us to schedule a call.

References

Gartner Research Note: Embrace Total Experience to Improve Medicare Advantage Star Ratings – ID G00742172

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