Industry leaders shared exclusive insights and best practices during RISE’s 11th Annual Star Ratings Master Class held virtually mid-December. Here are five actionable tips to ensure a positive member experience while improving quality scores.
During the Star Ratings Master Class, Ryan Davis, senior manager, product operations (Medicare), Centene Corporation, and Kate Rollins, senior vice president, population health and clinical innovations, Gorman Health Group, presented a session focused on the impact of COVID-19 on Medicare members and the necessary shift it will require for Stars strategy.
“The path you take over the next year or years to come will largely be dependent on how COVID has affected your organization and how your organization views Stars,” said Rollins. “We are at a point where we need to change our approach for Stars strategy.”
Throughout their presentation, Rollins and Davis shared five strategies for a Medicare Part-D 5-star rating:
Refocus efforts and oversight to measures often overlooked: Because COVID-19 has caused unknowns regarding the role of HEDIS and CAHPS, Davis recommended plans provide ample oversight of measures that are typically delegated with little oversight. Ensuring accurate data and touchpoints within each measure can make a significant difference.
Measures to consider prioritizing include:
- Medicare Plan Finder (MPF) price accuracy: Utilize the MPF/DestinationRx preview periods to review plan information, Prescription Drug Even data, and accuracy of the network and pricing.
- Medication Therapy Management (MTM): Look at different data sources to review how successful your plan is in engaging members and performing comprehensive medication reviews.
- Appeals upheld: Although this measure was due to be retired, Davis advised plans revisit the measure as a precaution by assessing ways to improve measure performance through informal training, the language used, and the overall process.
Evaluate the strategy and touchpoints for operational areas: Many of the operational areas responsible for Part D measures operate in siloes. Therefore, Davis said your plan must evaluate these member outreaches to ensure you make the most of them. “Member engagement is really important when it comes to how you tackle some of these Part D measures.” Davis recommended plans consider their touchpoints within areas such as care/disease management, new member onboarding, drug conversions, and medication therapy management.
Analyze enrollment data in real-time: Many plans don’t assign a true owner to the measure that tracks the number of beneficiaries who choose to leave a plan, noted Davis. Because the Centers for Medicare & Medicaid Services will track the number of beneficiaries who choose to leave a plan and assign a metric based on that number, it’s an area of opportunity for plans to have more involvement and proactive action.
Davis recommended plans check enrollment data in real-time to stay abreast of any member dissatisfaction with certain aspects of the plan so they can make necessary improvements.
Develop a comprehensive approach to identify the intersections between measures: Not all measures are mutually exclusive, explained Rollins. Health plans must develop a strategy based on where measures come together and explore how that relationship impacts members from a holistic viewpoint. Focus on the overall goal of a measure rather than the actual measure itself, advised Rollins. “At the end of the day, if you keep the member in mind at the top and focus on these initiatives, things are going to fall into place and you’re going to be successful.”
Manage and optimize intersections—work smarter not harder: Rather than focus on gaps, prioritize the members’ needs, meet them where they are, and the rest will fall into place, said Rollins, who also recommended plans coordinate member calls and correspondence to reduce duplicated efforts and maintain workflow throughout the year.