MA Plans Look Across Population to Improve Patient Experience

Medicare Advantage plans are at a critical juncture in their quest for quality bonus payments, as this month marks the end of a three-month data collection cycle that will have a meaningful impact on the 2023 star ratings, when member experience measures take on a larger weight in star ratings calculations. While it’s too late to make a difference in how members responded to the recent Consumer Assessment of Healthcare Providers and Systems (CAHPS) that reflects the patient experience in late 2020 and early 2021, MA organizations should be focused on innovations that can prevent and resolve issues members face throughout the year to foster more positive feedback for future surveys, advises one longtime stars expert.

As numerous measures based on CAHPS and CMS administrative data move from a weighting value of 2 to 4 starting with measurement year 2021, the increased value of those measures will make up 32% of the overall 2023 star rating on a weighted basis. “Just two years ago it was only worth half that much, so we literally doubled the relative value of CAHPS and the measured member experience through these surveys in the math path toward 4 stars,” says Melissa Smith, who is executive vice president of consulting and professional services at HealthMine, Inc., a Dallas- based member engagement firm. “We’ve always known member experience was important and we’ve always agreed we need to focus effort and attention in that area, but attaching such a heavy contribution to the overall star ratings to the surveys is the forcing function that most plans are seeing as the impetus for new actions.”

© 2021 MMIT

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues, including drug benefits and specialty pharmacy, for more than a decade. She served as editor of Drug Benefit News (the predecessor to Radar on Drug Benefits) from 2004 to 2005 and again from 2011 to 2016, and now manages Radar on Medicare Advantage. Lauren graduated from Vassar College with a B.A. in English.

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