April Gill

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Earlier this year, the Centers for Medicare & Medicaid Services (CMS) 

 several changes to Medicare Advantage that will take effect in 2023. The changes are aimed at advancing CMS’s vision for health equity, driving comprehensive, person-centered care, and promoting Medicare affordability and sustainability. They include updates to Medicare Advantage capitation rates, Part C and Part D payment policies, and Star Ratings. 

Star ratings should be of particular interest to health plans, health systems, members, and patients alike. Star Ratings reflect the quality of care a health plan delivers, and a large portion also reflect a patients’ experiences with health plans. As such, member or patient experience can play an important role in a plan’s quality, member retention, and recruitment strategies.

The Star Rating system helps Medicare beneficiaries, their families, and caregivers compare the quality of Medicare Advantage and Part D prescription drug plans. Star Ratings reflect the experiences of people enrolled in those plans by incorporating member feedback from CAHPS and HOS surveys into a plan’s overall Star Rating. CMS releases the Star Ratings annually in order to provide people with information to help them make informed choices about which Medicare plan is best for them.

Significant changes to Star Ratings are in store for 2023, which will directly impact health plans in many ways (e.g., their ability to market to members year-round). Here are three things health plans should act on now to maintain or boost quality scores, plan growth and retention, and financial health.

Quadruple weighting of member satisfaction scores


Star Rating measures will become quadruple weighted for patient experience in 2023, making these measures a critical component of a health plan’s overall future Star Ratings strategy. A proven way to boost member satisfaction is by using data, technology, and multi-channel communications to create a personalized welcome and onboarding experience, which can then be leveraged as a springboard for year-long member engagement. J.D. Power’s 2021 U.S. 

Medicare Advantage Study found that health plans that communicate effectively with members see higher satisfaction rates. This includes successfully engaging with members to answer questions and/or solve problems, making sure members fully understand their out-of-pocket costs, providing health education, delivering useful reminders for preventive services, and other communications. The more often a member feels seen and heard, and uses their benefits, the happier they will be.

Future health equity quality measure for Star Ratings


During the comments period, CMS solicited feedback on the development of a Health Equity Index to assess how plans screen for social needs such as food insecurity, housing insecurity, and transportation challenges. While a quality measure may need time to come to fruition, there are several steps health plans can take now to better address the social needs of vulnerable populations. 

For example, with social determinants of health data and predictive analytics, it is possible to identify which members are likely to have problems related to education and literacy, lack of material resources such as access to healthy food or transportation, among other social needs. With this type of information, health plans can intelligently develop their plan design and, down the road, leverage personalized communications and targeted outreach to offer members relevant programs to help close care gaps by meeting their immediate needs and/or removing barriers to care.

A return to pre-pandemic quality measure calculations


During the COVID-19 pandemic, CMS allowed health plans to use carryover quality measures for 2021 and 2022, resulting in a higher-than-average number of high scores. For example, 74 health plans earned a five-star rating in 2022 compared to just 21 in 2021, according to CMS. This has been great for member retention and reimbursement levels, but what will happen in 2023 when these concessions end? 

Health plans need to act now by executing effective member engagement strategies to drive members to take actions that can help improve their health, such as scheduling a preventive care visit or completing a missed screening. Greater engagement and action now can lead to future higher member satisfaction scores for their plans.

There are a lot of changes coming when it comes to Star Ratings, and keeping them high will be a challenge, but not impossible. Member expectations are at an all-time high, with 80% of Medicare Advantage members enrolled in a plan with 4 or more Stars. With healthcare consumerism on the rise, it’s important to make a positive impression early on in the member journey and provide actionable steps to help improve their health and wellbeing. Innovative health plans can begin taking steps now to better engage and support their members and help drive improvements in patient outcomes and Star Ratings alike. 

Data, predictive analytics, and multi-channel, multi-cycle outreach are critical for addressing each of these areas. They can drive higher engagement and actions like closing gaps in care – which can help health plans maintain and improve Star Ratings. A digital-first approach should be implemented from day one of a member signing up with a plan and continue throughout the lifetime of their membership. This should include creating a personalized welcome and onboarding experience, and developing and regularly sharing timely, easy-to-understand information aimed at support a member’s individual health and wellness journey. 

Multi-channel communications should be informed by deep, data-driven insights into the member’s life, experiences, and social needs, and should be delivered in the channels that they are most likely to engage with (e.g., email, automated voice calls, text message), based on their personal preferences. This approach can help boost member satisfaction now and for years to come.

April Gill is executive vice president and general manager of Health Plans & Health Systems at Virgin Pulse.

Articles

Significant changes to Star Ratings are in store for 2023, which will directly impact health plans in many ways. For example, their ability to market to members year-round. Included are three things health plans should act on now to maintain or boost quality scores, plan growth and retention, and financial health.

3 Things to Act on for 2023 Star Ratings

COVID-19 has taken a lot from us, including the ability to check in on many patients in person. According to CDC data, nearly 

 take at least one prescription drug, and nearly a fourth take three or more. However, adherence is an issue; even without a global health crisis, some 

 have shown medication nonadherence affected as many as 40% to 50% of people with chronic conditions.

Health plans, pharmacies, and providers alike are asking themselves important questions about those they serve with chronic conditions like, “Are they remembering to take their medications? Are they too scared to go to the pharmacy to get a refill? Are they having to choose between buying weekly groceries or the prescription I gave them?”

These questions and situations are real because condition management doesn’t stop in a crisis. In fact, in times like these, people need support now more than ever to remember daily habits to manage their diet, reduce stress, and take recommended medications. Doing so during the COVID-19 pandemic is especially important since people need to minimize unplanned clinical visits and keep the healthcare system freed up-as much as possible-to focus on managing critically ill patients.

Is the Final Word on Ibuprofen and COVID-19 Risk?

Health plans and pharmacies can play a key role in this process by helping people adhere to prescribed medications. Most have already accommodated early refills, mail order options and 90-day supplies. The next step is making sure people know about these changes and getting them to actively refill medications.

Here are four things we’ve learned along the way that your organization can use to boost adherence in response to the COVID-19 pandemic.

4 Tips to Drive Medication Adherence During COVID-19

. Analytics and predictive modeling can identify who is at highest risk for non-compliance so you can better target your outreach. This includes taking into consideration factors that could change frequently, like social determinants of health (SDoH). Some factors of SDoH are financial stability, education level, and living situation, among others.

. Different channels are more effective for different things. We have seen interactive voice response (IVR) work best for automated refill reminders, live-agent calls for connecting with high-need individuals, text for daily medication reminders, and postcards for mail-order medications

Refer to relevant, local resources and use barrier breaking questions such as, “Are you ready to refill?” Also, reach out to members using multiple touch points.

Use analytics to predict receptivity and likelihood to respond, coordinate message across your organization and offer self-serve options like chatbot or interactive texting

By incorporating these tips, organizations will connect with members and be a dependable resource for them during this time of uncertainty. Now is the time to be communicating with patients/members, as it’s important they can feel confident knowing where to turn to focus on health and wellbeing.

April Gill is senior vice president of Market Solutions, Welltok.

Four tips that will help drive medication adherence during COVID-19.

Medication Adherence During COVID-19 

Today’s seniors are not the same as generations past. They are living longer, more independently and becoming more tech savvy. This is in part due to innovations in science and medicine, alongside advancements that are fueling a rapidly growing ecosystem designed to better support seniors. 65 is the new 45.

As the population thrives and grows, so does the Medicare market. Approximately 60 million Americans are projected to be covered by 

, and over 40% of beneficiaries expect to be enrolled in Medicare Advantage plans in the next 10 years. Savvy health plans are quickly acknowledging this tidal shift and are acting upon it, customizing offerings to differentiate themselves and provide seniors support across all aspects of health.  

With new rules allowing consumers to switch plans well into the first three months of the year, the Medicare Advantage market is becoming more competitive. For plans to attract, retain, and better manage this growing market, they must understand this increasingly diverse population and meet members’ individual needs in a meaningful way.

Why Some Groups Want to Kill Medicare for All

It is important that healthcare executives stay in tune with elder Americans and be prepared to respond. According to the results of a 

 of more than 1,000 adults over the age of 65, seniors are feeling younger than ever and have redefined what they perceive as being “healthy.” They are also aware of their options and are not afraid to shop around.

as approximately four in five say they feel younger than their actual age. Nearly 90% say they also feel healthier than their parents’ generation. 

 support these feelings as increased physical activity and social engagement in recent years have helped seniors stay healthy as they age.

Health encompasses far more than counting steps. 

To improve quality of life, seniors are adopting a new definition of health that incorporates physical, social, emotional and financial aspects. Financial stability (94%), adequate sleep (91%), and positive relationships (90%) are most important for seniors to achieve and maintain. Managing stress, good nutrition, and then maintaining an appropriate level of physical activity followed in importance. Developing plans that incorporate and balance each of these areas of health will be critical for any insurer that wants to maintain a competitive edge.

with nearly six in 10 seniors agreeing that they would consider switching their current Medicare Advantage plan in the near future. A combination of low out-of-pocket costs, prescription drug coverage and in-network access to providers emerged as primary factors that could influence a plan change. Seniors also feel that insurance providers should offer programs and resources that address their total health and well-being. Yet, roughly half feel that their current plan is not offering relevant or personalized support. Innovative health plans must keep this in mind when designing and communicating benefits within their Medicare Advantage offerings. This means getting to know seniors at an individual level by leveraging all available data-not just retrospective claims data. Leveraging non-healthcare data such as purchasing data, household composition, and voting frequency will help insurance executives personalize these programs so they are more relevant and drive action.

Seniors want the full package of support.

 found that three out of four people age 50 and older prefer to remain in their homes as long as possible. As 

 becomes more common, health plans will need to learn how to support this trend. With innovative plan designs, such as including coverage for durable medical equipment, insurers can better support holistic health and keep seniors happier and healthier-wherever they want to spend their golden years!

Email is king, but texting and calls are also important communication mediums for seniors

. The new data also revealed how seniors like to receive communications from their health plans. Email emerged as the top preferred medium, especially among Medicare Advantage members (52%), followed by phone (automated voice or live agent) and regular mail. There is also growing interest in connecting digitally, including text messaging. Health executives need to capture and respect communication preferences for consumers to most effectively engage them, whether it is via email, digital voice, traditional mail, or a combination of multiple channels.

The results of this new survey show that seniors are far from one homogenous, technophobic group. As the baby boomer generation continues to rapidly age into Medicare, this diverse population will only continue to grow. Now is the time for health executives to start personalizing and properly communicating with seniors to ensure they are able to successfully attract and retain new Medicare Advantage members, while also keeping the seniors of America happy and healthy.

April Gill is the vice president of health plan market solutions at Welltok, a consumer health SaaS company.

How to make Medicare Advantage plans attractive by meeting the needs of a new generation of senior patients.

April Gill

Articles

3 Things to Act on for 2023 Star Ratings

Medication Adherence During COVID-19

65 Is the New 45: Five Ways Seniors Can Reach Well-Being Goals