It is a new year; many health plans are implementing new programs & initiatives to improve quality care and experience for their members. Changes to the Healthcare Effectiveness Data and Information Set (HEDIS)® for measurement year 2022 are afoot across Medicaid, Medicare Advantage, and Commercial Health Plans. In addition, Medicare Advantage plans continue to adjust to the measure weighting assigned to Consumer Assessment of Healthcare Providers and Systems (CAHPS)® survey as well as changes to the Health Outcomes Survey (HOS)® measures.
The Centers for Medicare and Medicaid Services (CMS) continue to encourage value-based care and program design, paying for quality and experience— and measure changes could significantly impact the way health plans and their provider partners engage and interact with patients, especially beneficiaries who need help managing one or more chronic conditions, complicated by social determinants of health (SDOH).
The recent proposed rule and Advance Notice indicate that future measures of healthcare disparities are on the horizon. For now, HEDIS and CAHPS measures offer new opportunities for health plans to elevate their standards of care, motivate members and engage differently — which could make a big difference in the lives of those who are underserved by traditional approaches.
Adjustments to the HEDIS measures, which went into effect on Jan. 1, 2022 demonstrate the quality communities’ commitment to health equity, life quality, and patient-centered care. NCQA introduced race and ethnicity stratifications to five HEDIS measures as a first step to addressing and reducing health disparities. 2024 Medicare Star Ratings (based on calendar year 2022) include an updated Plan all Cause Readmission (PCR) measure and the increase of Controlling Blood Pressure (CBP) to a weight of 3.
Contract Year 2021 Medicare Advantage and Part D Final Rule doubled the weight of CAHPS patient experience measures to 4x weight for calendar year 2021 (Stars 2023). In the last few years, Medicare Advantage plans have seen member experience measures contribute to nearly a third of the total Star Rating.
The aforementioned CY2023 Proposed Rule and Advanced Notices highlighted potential development of “a measure to assess whether plans are screening their enrollees for health-related social needs such as food, housing, and transportation.” Coupled with the race & ethnicity stratification, plans are poised to learn more about their memberships’ needs and must continue to respond appropriately.
While CAHPS and HEDIS are not new measurement tools, the changes present new challenges for health plans that have often struggled to reach and engage the members who need the most support. Here are three ways health plans can boost their performance in these areas and improve their relationship with members.
While measure changes may take some adjustment, health plans that focus on improving member experience, expanding access to care and engaging individuals in new ways will be poised to succeed in 2022.
HEDIS(R) is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS(R), which stands for Consumer Assessment of Healthcare Providers and Systems, is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).