The Center for Medicare and Medicare Services (CMS) Stars scores were designed to measure how well health plans are helping members stay healthy—and happy—using five categories:
But the ratings go beyond a label and can impact reimbursements, member decisions to enroll and stay, and even incur penalties if certain standards are not met.
Digital health platforms like Wellth can help plans improve performance in these areas through easy-to-use platforms that improve member health, have high member satisfaction rates, and even give back to members through meaningful incentive programs.
Preventative care—including vaccines, screenings, and tests—are an important component of the Stars ratings. But getting members to take the appropriate preventative care can be more difficult in implementation than in ideology.
Last year, less than 50% of the U.S. population received a flu shot—even with the pandemic—suggesting that payers need to do more to incentivize the members themselves.
Digital health platforms like Wellth can offer customized reminders and incentives for key preventative behaviors that are specific to each individual member’s needs.
For example, sending a reminder and incentivizing a yearly optometrist visit for members with diabetes can help ensure diabetic retinopathy is caught early on, allowing appropriate treatment to be taken.
The COVID-19 pandemic has caused challenges in caring for members with chronic conditions. Not only do certain chronic conditions make members more susceptible to the virus, but as these high-risk populations are encouraged to stay home, regular visits to a provider office are halted—leading to condition exacerbation for many. This makes medication adherence even more important, and it is strongly weighted as part of the Stars scores.
Wellth can help plans support members with chronic conditions by ensuring they develop healthy habits at home—including medication and medical device adherence, healthy diets, and more.
The Tokio Marine Calvo's SelectCare Health Plan partnered with Wellth to offer member incentives for medication adherence and subsequently reduce HbA1c levels. As a result 67% of enrolled members improved their PDC—and 86% of members who were not previously adherent increased their PDC. In total, 94% of enrolled members in the incentive program became adherent to their medication, leading to an improvement in HbA1c for 80% of enrolled members.
The 2021 Star ratings place significant emphasis on the member experience—quadruple weighting it for 32% of the overall Stars rating. Success in these metrics, and achieving good CAHPS scores, starts with good customer loyalty.
Net Promoter Score (NPS) is commonly used to measure a customer’s willingness to recommend the company to another. In the healthcare industry, 27 is considered a good NPS score, and studies have shown that there is a significant—r=0.58—correlation between NPS and overall member satisfaction, suggesting that success in CAHPS scores is tied to higher NPS scores.
Wellth has an average Net Promoter Score of 88+, showing that our members are satisfied with their care.
Surveys suggest that approximately half of respondents change insurance at least once in every three years, and the administrative cost of navigating these frequent changes is high.
Creating better member satisfaction is the first step in reducing unnecessary administrative costs and ultimately achieving better Star scores. When plans partner with programs like Wellth, the unique offerings and incentive programs that speak to the needs of members can help boost member satisfaction.
In Medicare Advantage populations, 37% of members have an annual income of $20,000 or less. This impacts housing, food stability, education, transportation, and more—all of which can act as barriers to an individual’s health.
The majority of Wellth members use their incentive money to purchase groceries (27%) or other food (21%), pay for prescriptions (8%), gas (7%), and other necessities. Those who don’t use the incentives to pay for little treats—such as coffee and a bagel.
Benefits like these can help members feel cared for—inside and outside brick and mortar offices—leading to better satisfaction.
For more information about boosting retention, check out “Three Strategies for Boosting Member Retention.”
While customer service ratings are directly tied to health plan efforts, Wellth’s support team can help by acting as a bridge between members and health plan customer service.
As members check in each day, our support team monitors for increased risk of nonadherence, and missed check-ins—alerting our partners’ care team when additional action is needed. This real-time feedback enables teams to follow-up more quickly on issues that arise for happier members and better patient care.
To learn more about improving Stars scores with Wellth–as well as the updates to 2021 CMS policies—check out our new eBook: Navigating Chronic Conditions: What payers need to know about the 2021 CMS policies and how to address them with digital health.