So, your organization offers an effective and competitive Medicare Advantage (MA) plan. Well, you get a “Star” for that. Hopefully, you get more than one star. Five Stars would be excellent.
Of course, we’re talking about the Star Rating System, introduced by the Centers for Medicare & Medicaid Services (CMS) in 2008 and updated every year. But just how important is your Medicare Star Rating to the health of your private plan? Let’s look…
Don’t Become a Falling Star
Health plans obviously want to achieve a rating of 5 stars. What you don’t want is to become a fallen star. When a plan’s Star Rating drops below a certain number, undesirable things can – and do – happen:
- Millions in lost opportunity
- Loss of revenue
- CMS can actually terminate a contract that has failed to receive at least three stars for three consecutive contract years.
A Rising Star Can Yield Success
But, as you might guess, raising your Star Rating can have a positive effect. This analysis from Guidehouse/Navigant shows the positive impact of Medicare Advantage star ratings improvements on plan enrollment and revenue:
- A 1-star rating improvement could, on average, lead to a year-over-year 8 percent to 12 percent increase in plan enrollment.
- Improving from a 3-star to a 4-star rating could increase revenue between 13.4 percent and 17.6 percent.
Communicate Well with Plan Members
So, how does a health plan help maintain or achieve a “very good” to “excellent” Star rating? Well, we know that the health plan relies on information from plan member satisfaction surveys, healthcare plans, healthcare providers, and other sources to develop its Star Ratings. You would think that private plan members/users would be primarily interested in the clinical care delivery side of healthcare. But that’s not totally accurate. We found that plan members can, in fact, be positively impacted by their plan’s communications efforts.
Suggestion: Communicate and Connect with Plan Members
O’Neil is a data and member communications company that helps both healthcare and financial services companies communicate more effectively with their audiences. For healthcare, this is largely health insurance plan members. We are less focused on the clinical care delivery side of healthcare, and more on the communications and insurance components. Here are some ways that O’Neil Digital Solutions can help you communicate with, and even delight, your plan members:
- Build awareness for your plan’s brand.
- Provide data analytics to create “Personalized Personas” for each member.
- Produce/deliver welcome documents including a welcome kit, acknowledgment letter, member orientation handbook, ID card, enrollment confirmation letter, directory, plan overview, value-added-services brochure, provider directory, drug guide, and other items.
- Produce/deliver an evidence of coverage document, annual notice of change document, explanation of benefits, compliance letter, billing statements, information for setting up an automatic prescription renewal, other items.
Suggestion: Communicate in Ways your Customers Appreciate
This is very important, though: You must communicate with your plan members where and how they prefer. O’Neil can help you provide a seamless, personalized communications experience whether your plan members prefer to engage with your company via your website, mobile apps, social media, electronic media, traditional print, other.
In addition, we exited to be creating a tool that will both evaluate and score the effectiveness, efficiency, and cost of your company’s communications efforts to your plan members.
A Thumbs up for the Star Rating System
Here at O’Neil Digital Solutions, we see value in the Star Rating system and believe this federal government program does some things quite well:
- Makes it easier for people seeking a health plan, to compare the scores of available plans. Using current data, beneficiaries and their loved ones can then make informed plan choices based on plan performance and quality of services.
- Allows plans throughout the healthcare industry to see how they compare with each other – and how they compete with each other.
- Finally (and maybe most important) the Star rating system does an admirable job of holding health plans and healthcare providers accountable for quality. There is truly a correlation between higher-quality health care and higher-quality health.
Four Stars or Higher
According to this Medicare Fact Sheet – 2020, approximately 52 percent of MA-PDs (210 contracts) that will be offered in 2020 earned 4 stars or higher for their 2020 overall rating. Weighted by enrollment, approximately 81 percent of MA-PD enrollees are currently in contracts that will have 4 or more stars in 2020.
Need help sorting through it all? O’Neil Digital Solutions is ready to advise or simply answer your questions. O’Neil specializes in all aspects of Managed Healthcare member communications including Commercial, Medicare, Part D, Medicaid and Individual Membership communications. We understand the latest government and CMS requirements and we have solutions in place to help you personalize your healthcare communications to your membership and keep you in compliance. Contact us here.
