MA Plans’ Stars Innovations Prioritize Member Experience

In the ever-evolving world of star ratings, Medicare Advantage plans are at a unique crossroads where they must balance a bevy of changes to the measures used to determine their overall rating with managing members’ health and needs during the ongoing COVID-19 pandemic. And with CMS placing more emphasis on member experience in the star ratings, plans are encouraged to apply lessons learned from the pandemic about how to communicate and maintain good relationships with members, several experts advised during the Fourth Annual Medicare Advantage Leadership Innovations conference, which was held virtually on Jan. 26-28 by Strategic Solutions Network.

According to Melissa Newton Smith, executive vice president of consulting and professional services with HealthMine, Inc., more than half of a plan’s overall star rating is subject to changes that have just taken effect or are taking effect in 2021 or 2022, thereby impacting the 2023 and 2024 star ratings. Those include “additions, removals, weighting changes or significant specification changes to 23 of our 44 star measures,” Smith told attendees. “That should be causing us to innovate with changes to our processes, to our technology and tools, to our budgets no doubt, and possibly to the type of work our people are doing at our core in order to keep up with these program changes.”

© 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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