Industry Voices—Attention Medicare Advantage plans: It's not too late to meet year-end goals

Medicare Advantage
Medicare Advantage plans still have time to meet their year-end goals. (Getty/designer491)

It’s that time of year for Medicare Advantage plans to make their stars align.

Each year, the Centers for Medicare & Medicaid Services (CMS) ranks Medicare Advantage plans from one to five stars based on how well a plan performs in various categories, including quality of care and customer service. For most plans in today’s increasingly competitive market, staying at or above the 4-star threshold is vital, while three stars or below can be the kiss of death.

Medicare members have more and more options, and they’re moving to higher-rated plans that deliver better value. On average, nearly three-quarters (72%) of Medicare members choose plans with a minimum 4-star quality rating. 

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As fall approaches, the bulk of Medicare Advantage plans rest in one of two camps: those that are confident they will meet their quality and member satisfaction goals by the end of the year, and those that are not, either as a result of poor in-year performance or falling short of their goals last year. 

RELATED: Kaiser leads the way in average Medicare Advantage star ratings for 2019

The dynamics of the star rating system can make it tricky to navigate, as thresholds can shift and affect a plan’s performance. Even small movements from year to year can have a huge impact on an organization’s ability to meet goals or could result in a plan missing them altogether. This year’s star ratings won’t be released until October, and by then it may be too late for plans to take meaningful action.

Now is the time for plans to act as the homestretch of 2019 approaches.

For plans that are on track, don’t rest easy

Some plans may be confident in their quality and satisfaction data so far this year, but that doesn’t necessarily mean they are in the clear. Here are two things plans should keep in mind:

  • Certain star rating measures are more volatile than others. Some measures can fluctuate by as much as 9% from year to year—last year alone, seven measures saw significant changes. This means that even if a plan appears to be on track, it could be a very different story by the time actual ratings thresholds are announced.

  • Even if projections look good, they could end up missing the mark. I know of one large health plan that used sophisticated modeling to project where their star ratings would land. In some cases, however, their actual performance fell short by as much as 3%, which could actually be the difference between moving up or falling back. Last year, 76 Medicare contracts fell short of a 4-star rating due to these types of shifts.

RELATED: Industry Voices—Why MA star ratings should account for the social determinants of health

The bottom line is, even if plans are feeling good about their performance so far this year, they may still need to implement some short-term strategies to ensure they meet their targets. Based on years of working with nearly 40 health plans and serving nearly 15 million consumers across all 50 states, here are four strategies we at NovuHealth recommend to boost quality and member satisfaction by year-end:

  • Prioritize the measures that matter. This late in the game, plans don't have the time, budget or bandwidth to focus on every single star measure. Instead, they should prioritize the top two or three that matter most to their quality goals and deploy personalized campaigns for members who need to close those specific gaps.

  • Focus on members most likely to take action. Plans should identify historically compliant members who are overdue for gap closure based on when they completed their activities the previous year and send them personalized communications about these open gaps. In addition, propensity modeling can be used to determine which members in noncompliant populations are most likely to take action, enabling plans to focus dollars and resources where they are most needed and effective. Taking a less targeted approach not only jeopardizes plan performance, but it also results in reward and incentive programs that can’t show a positive return on investment.

  • Include a sense of urgency. Reminding members that they only have a few months left to close their open care gaps and reinforcing the benefits of acting fast (or risks of failing to act at all) can be all the motivation some members need. In addition, offering members quick and easy reward redemption options such as digital gift cards builds a positive association between behavior and reward. 

  • Use rewards strategically. Once plans have identified the measures most impactful for quality and member satisfaction, they can overlay various rewards strategies—a $25 gift card for an annual wellness visit, for example—to incentivize completion. This applies to short-term activities such as patients with diabetes checking their A1C levels, as well as exams that have a longer lasting impact on health, such as colonoscopies, which often need to be completed less frequently. This helps get members to the care they need, while also contributing to improved quality and satisfaction measures.

Star ratings are vital for Medicare Advantage plans. For those plans tracking below projections, there is still time to make an impact. And for those on track to meet their objectives, there may still be work to be done. In either case, taking a thoughtful and measured approach in motivating members to close key care gaps can make all the difference.

Cory Busse is a senior director, healthcare engagement strategist at NovuHealth

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