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Mandatory CMS Star Ratings Are Coming to Exchange Plans


The Centers for Medicare & Medicaid Services (CMS) recently announced it will require commercial health plans to display Star quality ratings on Exchange websites. This requirement will go into effect beginning with the 2020 enrollment period. To better understand what this change means for these plans, we spoke to Glen Olson, Vice President of Business Development at Carenet Health.

What should exchange plans know about the CMS Star ratings?

The rating system is intended to give healthcare consumers a way to compare health plan quality. Five stars represent the highest quality. Plans are rated in three categories: Member Experience, which is based on satisfaction with things like doctor performance and appointment scheduling; Medical Care, including the availability of regular screenings, vaccines and other basic health services; and Plan Administration, which covers customer service, access to network providers and more. The ratings will be revealed on November 1, so shoppers can use the information to make choices during the Affordable Care Act (ACA) open enrollment period. It’s going to be a significant change to have that data out there—it’s a big deal for these organizations.

Give us a quick history of the Star ratings.

The system was introduced in 2017 and was originally only mandatory for Medicare Advantage and stand-alone Part D plans. Carenet has been working with those plans since the beginning to help them improve their Star ratings.

Of course, the initiative has had its share of controversy. Many industry leaders believe the methodology is flawed. The measures seem to be in constant flux and re-evaluation. It’s also been difficult for plans to achieve five-star status. In the 2019 scores, only 15 of the 376 rated Medicare Advantage plan contracts achieved five stars.

What does this mean for member engagement at these exchange plans?

Positive, effective, ongoing engagement will be more important than ever. These commercial plans need to leverage every   possible resource to understand member trends and quickly identify opportunities for intervention, since Star ratings are heavily influenced by the member experience. And keep in mind—member satisfaction isn’t set in stone. Perceptions can change from one visit to the next, so satisfaction measurement needs to be a year-round activity.

The bottom line for engagement design is this: To really achieve five-star status, the member’s needs must come before the plan’s. A member-centric strategy that involves intentional touchpoints and personalized messaging—all with the goal of making it easier for the member to interact with the plan—is the key to success.

Will there be distinct differences in Star strategies between Medicare Advantage and these exchange plans?

Absolutely. The ACA exchange plan population is a younger demographic compared to the Medicare population. Nearly 40% of exchange enrollees have been in their 30s to mid-50s. That demographic is more likely to shop around during each open enrollment period and have higher expectations of the plan experience.

This means a different approach is necessary to engage these consumers before, during and after they become members. Use of a variety of engagement channels, including one- and two-way texting and even social media, will come into play, too. Millennials have made up about 30% or so of the ACA plan population, as well. Telehealth and other on-demand experience offerings will likely be important to that group.

Anything else plans on the commercial exchanges should think about?

In areas where competition among commercial plans is low, the Star ratings will likely carry less weight with consumers. That means plans in these areas must find other ways to spread the word about their quality and commitment to member satisfaction. Member loyalty and referrals will become even more critical.

Read more about strategies for five-star status here.

 >>> How can Carenet help? We can customize an engagement strategy to meet the unique needs of your population. Contact us if you’d like to plan now for ways to impact your Star ratings.