Was your 2022 Star rating score too close for comfort? Pay attention to these three trends as you look to the (near) future.

1. The “consumerization” of health care is here to stay

COVID toppled persistent barriers and hastened digital health at breakneck speed. It pushed consumers to rely on digital channels for care, with most embracing the innovation and realizing that the flexibility and convenience born of technology led to empowerment for self-management of their conditions. Consumers are setting new priorities, developing a new experience-centered mindset, a greater sense of urgency about their well-being, and a strong desire to actively manage and direct their own health. Today, more than ever consumers expect care solutions that are uniquely personalized, help achieve their individual goals and deliver integrated care experiences within a “healthsphere” of payers, providers, and suppliers all working together to improve outcomes and value. Loyalty and good will can be earned by offering health plan members information, tools, and an abundance of options to access their care how, when, and where they want.
RELATED: CMS releases 2022 MA and Part D Star ratings

2. If you want “extreme trust” lead with “extreme transparency”

Recent federal mandates and shifting consumer expectations are democratizing health data more and more each day. Don’t resist this important trend. Information transparency empowers members to dynamically engage in their own care, participating fully as part of their care team and making the choices that work best for them. How do we gain members’ trust so that they engage with our quality programs, tools, and services? One-size fits all approaches no longer work. Treat each member as a unique person, instead of a “persona,” and tailor their health experiences based on individual preferences. By letting each member decide what they’re willing to share with us during each interaction, we can show them the value they receive through sharing information with us. In its excellent piece, The Health Experience Reimagined, Accenture describes “pushing out an alert with tailored nutrition options because a patient’s blood pressure jumped outside his or her target range due to food eaten” as an example of how this concept could be applied. And we shouldn’t just be transparent about the data we collect, we should also wholeheartedly embrace the latest mandates (Interoperability, Hospital Price Transparency, Transparency in Coverage, and the No Surprises Act) supporting the electronic exchange of data that ease the way for the flow of cost-sharing and pricing information that consumers need. The more we share, the more our members will trust us to create truly meaningful health care experiences for them. Organizations that lead with pricing transparency and combine that information with quality and outcomes transparency will reap the benefits of being trustable partners for the long term.

3. Meeting members “where they are” increasingly means meeting them at home

The shift from traditional care settings to home-based care is happening at lightning speed, and COVID has only served to accelerate this trend. Payers and providers should reimagine care delivery, freeing it from the limitations of time and place. Why should patients be limited to receiving care in physical locations and only during the times those offices are open? Whenever possible, we should rethink where, when, and how care is delivered… leveraging technologies like telehealth, home testing, telemonitoring, and devices that facilitate the self-administration of treatment to facilitate care for patients whenever and wherever they need it, especially in the home. Tools, platforms, and services that facilitate care coordination will be critical to ensuring patients connect with what they need when facing a diagnosis of a long-term condition or an acute health event. More and more, patients are being discharged from hospitals to home, when they may previously have been discharged to a skilled nursing facility. Payers and providers can provide support to ensure patients follow medication and treatment regimens and participate in follow up appointments, no matter when or where that care takes place. And for those that need extra help adding personalized services, such as concierge, care navigation, or coaching helps ensure access to the right care at the right time. Benefits that facilitate self-direction, self-efficacy, and the delivery of care on each member’s own terms will be the key to driving higher satisfaction and improved health outcomes.

Looking ahead to 2022

As we close out this year and look forward to the year ahead, we expect these trends to continue. Pay close attention to these trends when planning for benefit design, quality programs, operational structure, resource allocation, and future investment. Doing so will go a long way towards aligning your organization’s key initiatives with a strategy that will pay dividends when it comes to member retention, higher satisfaction, and improved health outcomes, all factors that lead to sustained Star ratings success.


About the author

Ana Handshuh, principal at CAT5 Strategies, is a government programs executive with expertise in creating and implementing corporate programs for the health care industry. Her background includes quality, core measures, care management, benefit design and bid submission, accreditation, regulatory compliance, revenue management, communications, community-based care management programs and technology integration. Handshuh currently serves on the board of the Resource Initiative and Society for Education (RISE) and is the chair of RISE's Quality & Revenue Community. She is a sought after speaker on the national health care circuit in the areas of quality, Star ratings, care management, member and provider engagement, and revenue management. Her recent consultancy roles have included assisting organizations create programs to address the unmet care management needs in the highest risk strata of membership, document their processes and procedures, achieve accreditation status, design and submit government program bids, institute corporate-wide programs and create communications strategies and materials.