As CMS resumed normal Star Ratings calculations and gave greater weight to patient experience measures for 2023, the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning 4 stars or higher saw a dramatic drop from 2022, according to newly released CMS data. In Part 2 of an AIS Health series on successful Star Ratings strategies, top performers say maintaining a company-wide focus on quality and member experience is key to their approach. And while member outreach is a critical part of those initiatives, successful plans are careful to avoid overcommunicating with members and creating message fatigue, sources tell AIS Health, a division of MMIT.
Capital District Physicians’ Health Plan, Inc. (CDPHP), which is based in Albany, N.Y., retained 5 stars for both its MA PPO and HMO plans. “We understand there’s competition out there and we have to constantly change what we do [when we] interact with our members, but we’re proud to say two years in a row we’ve been able to do it yet [are] humble enough to know that we can always improve and that we have to stay focused on what the goal is,” Chief Quality Officer Renee Golderman tells AIS Health.
And while CMS for the 2022 Star Ratings extended plans the option of choosing the “better of” their 2021 or 2022 Star Rating on most measures because of the COVID-19 pandemic, Golderman says CDPHP used its 2021 scores for the majority of measures that year and believes it is on a “path to success” because of various tactics it has put in place.
Broadly speaking, those tactics break into three areas of focus: employees, members and providers. Starting with employees, “it is everybody’s responsibility to understand what their role or their job is to influence and impact quality,” remarks Golderman in an interview with AIS Health. That message is continually delivered at company town halls by CEO John Bennett, M.D., is filtered down by senior leadership and is part of goals set at team meetings. “To take it a step further, we try to make it fun,” using a mix of creative remote and in-person activities, she adds. For example, the company’s communications team created a “Drive to 5” graphic that appeared on notebooks, mousepads and other supplies that were sent to employees working remotely during the pandemic.
Golderman also frequently gives employee talks explaining what the ratings are and why they matter. She’ll explain that “it’s about being healthy, [managing] chronic conditions, being there for members, the member experience.…And then it’s how do they take that work and engage with our members and providers?” Before employees interact with members or doctors, they must go through “MAGIC” training, which stands for “making a great impression on a customer,” she adds.
Stressing the importance of screenings and preventive care, CDPHP also hosts a “HEDIS Hero” week, when it teaches employees about the Healthcare Effectiveness Data and Information Set measures. For example, it held an event in the parking lot that featured a giant replica of a colon. Employees could walk through it and ask questions of representatives from the American Cancer Society to gain a better understanding of the importance of colon cancer screening.
Meanwhile, CDPHP is careful not to duplicate messages and has an engagement communications committee that acts as a “centralized location” so that when a communication is going out to a member or to a provider, “it’s going to the right audience at the right time.”
While the CAHPS survey is a “huge focus” for CDPHP, it uses a “Customer Intimacy” program that offers members help with scheduling appointments and tips on how to talk to their doctor. Golderman points out that some stars measures address personal topics such as fall risk, mammograms or bladder incontinence. “Those are tough things sometimes for people to bring up with their doctor, so we have tools,” such as magnets that remind members to talk about certain topics at their next doctor visit, and try to help them work through any barriers they may have to accessing care, she says. Likewise, the company offers Customer Connect centers around its service area where members and non-members can seek in-person advice from health care advocates on anything from enrollment to scheduling appointments. In addition, CDPHP is doing some “really creative things in the pharmacy space,” like offering medication delivery in select areas through its Connect Rx Hometown program and allowing members to view prescriptions and compare drug costs through the ConnectRx On The Go app.
Finally, CDPHP is partly governed by physicians, with eight out of 15 board members required to be physicians. “Our board and all of our teams are very focused on supporting our physicians so that the physician can focus on keeping members healthy. So we work really hard to look at the tools the physicians need to deliver care comprehensively, to send information to them so that they can have a complete picture of care to augment what they do to care for their patients,” says Golderman. In addition, CDPHP has a “boots on the ground” physician engagement team that goes to physicians’ offices to interface with practices about what care gaps members might be facing, especially when it comes to preventive care screenings, and how CDPHP can help close those gaps.
Meanwhile, MVP Health Care prides itself on being the only insurer in New York to receive a 5-star rating for its Dual Eligible Special Needs Plan for 2023 and credits its ability to break down silos in care to address physical, behavioral and social health through constant contact with customers and their physicians.
“At MVP Health Care, our customer centric, data-driven approach to health care has led us to achieve a 2023 Medicare five-star rating,” says Carl Cameron, M.D., chief medical officer with the Schenectady, N.Y.-based insurer, in a statement emailed to AIS Health.
“While CMS considers many different factors when designating this status, what MVP prides itself on most is our ability to offer our customers a unique, personalized approach to health care. MVP has put our customers at the center of the health care system by making a fundamental shift in the way we interact with them. This includes distributing direct feedback surveys, [employing] the support of care navigators, and using data to identify unmet health needs of our customers in the market. Driven by our core values of being the difference for our customers, being humble, and being curious, MVP’s Medicare Advantage plans offer high-quality health care, exceptional customer experience, and a health plan that is raising the bar on personalized care.”
Independence Blue Cross in Pennsylvania also earned 5 stars for the second year in a row for its Keystone 65 HMO product, and its Personal Choice 65 PPO plans received 4 stars. Kortney Cruz, vice president of Medicare sales and marketing at Independence Blue Cross, says the 5-star rating is a “testament to our team’s hard work and commitment to provide high‐quality Medicare Advantage plans” and that “countless efforts” go into achieving that.
That includes “everything from the comprehensive health benefits we offer to the excellent customer service we provide to the programs we have in place to ensure members stay healthy and have access to transportation and nutritious foods,” Cruz says in an emailed statement. “We also collaborate closely with the providers in our network and have Registered Nurse Health Coaches available 24/7 to answer member questions. Our teams really do go above and beyond, and these ratings reflect that.”