Six Factors Holding Payers Back from Improving Star Ratings

Harrison

We all know how important Star Ratings are for Medicare Advantage (MA) health plans. Yet, many payers often overlook key opportunities to improve Health Outcomes Survey (HOS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures that together constitute 27% of an overall health plan’s score and 36% of their Part C score. Based on their overall weight, there is no doubt that HOS and CAHPS results can make or break a Star Rating improvement strategy.

However, HOS and CAHPS results remain relatively stagnant when compared to other Star performance measures. Why is this? Especially when these measures have such a substantial impact on Star Ratings? What is holding payers back from improving HOS and CAHPS?

HOS and CAHPS: Your last best opportunity to impact Star Ratings

The majority of Star measures are clearly defined based on specific services received, claims or medical record information verifying access and delivery of care. For example, a health plan can identify all members that have a chronic disease and further identify specific care received during the measurement year. Interventions to close gaps in care can then be deployed to proactively target and deliver positive outcomes.

This is not the case with HOS and CAHPS. These measures are based on member reported results and perceptions of care and service, rather than objective diagnoses or claims. HOS and CAHPS surveys are based on sampling methodology and the results are aggregated, so no specific member details are available. Plans are essentially blind to the populations performing well or poorly beyond overall market trends or significant shifts in results.

With limited actionable member data available, health plans often choose to just focus on broad, general interventions that affect the larger population and market trends; rather than clear, directive member-specific actions that could really improve HOS and CAHPS-and consequently, Star Ratings as well.

Ultimately, health plans need timely and detailed member information about care and service perceptions to create interventions that drive improvements in members’ health and overall care experience.

So how do we get there? Below are recommended steps for building an action plan to directly address (and improve) your HOS and CAHPS Star measures.

• Perform an off-cycle survey targeting your entire membership to gather member-level detail, barriers to care and insights into member perceptions. Interactive-voice-response or web-based surveys are faster, generally less expensive and have higher response rates than mail surveys. Plus, data can be compiled in real-time allowing for rapid analysis and interventions.
• Address high-risk members immediately by using triggers or alerts to identify those members based on negative responses. Once identified, provide immediate support through Care Management or Customer Service in order to mitigate possible issues and demonstrate your commitment to members.
•  Utilize survey insights to drive members to care and disease management programs that best meet their needs.
•  Expand your survey’s data set to also include specific questions about barriers to care, health and health insurance literacy and social determinants of health. Questions should focus on areas that you can address.
• Perform data analysis and data correlations across HOS and CAHPS question responses to best understand trends and identify key intervention opportunities. Compare HOS outcomes to CAHPS access, timeliness, and care coordination. For example, a common thread we see in our customers’ data is that members who have low scores on mental and physical health perceptions often also have low scores on provider access and care coordination questions.
• Drive continuous improvement in HOS and CAHPS measures with a multi-year strategy. Focus your resources on a limited number of interventions to drive results at first, and then expand to additional interventions the following years. It’s rare to move all measures significantly in one yearly cycle-so a long-term commitment and strategy is essential.

For health plans, the time to focus on improving HOS and CAHPS results is now. CMS recently reinforced their commitment to “measuring and reporting information from the consumer perspective for Medicare Advantage (MA) and Prescription Drug Plan (PDP) contracts.”

By following these steps, payers will have access to more actionable and detailed member data that they can use to effectively improve member outcomes and perceptions about care-and ultimately, improve their Star Ratings.

Ellen Harrison is vice president, market strategy and consulting for HMS. She brings more than 20 years’ experience in strategic planning, managed care operations and consulting experience. HMS provides a broad range of coordination of benefits, payment integrity, care management and member engagement solutions that help move the healthcare system forward.