3 Ways Wellth’s New Medicare Advantage Product is Revolutionizing the Approach to Star Ratings
Take a first-look into Wellth’s specialized Star Ratings Medicare Advantage Product launching in December 2023.
November 6, 2023

37% of Medicare Advantage Prescription Drug (MAPD) plans dropped in their 2024 Star Ratings. Many plans missed out on significant Quality Bonus Payments as over half of Star Ratings measure cut points increased. As COVID-era protections roll back and Health Equity measures become even more important, the trend of Medicare Advantage Star Ratings dropping is likely to continue unless plans start to implement big changes to their Star Ratings strategy. 

At the end of the year, Wellth is launching a brand new Medicare Advantage Star Ratings product that addresses the pain points plans are facing in their Star Ratings now and the changes that are yet to come. We are providing early insight into three key areas that Wellth is mastering to move the needle on your Star Ratings measures.

Big Benefits of Behavioral Science  

Wellth's backbone is daily engagement with its members - driven by behavioral science - which trends around 90%, meaning 9 out of 10 members interact with Wellth every day. The single biggest contributor to health outcomes is member behavior. Wellth members receive loss-based monetary incentives and complete tasks most relevant to their personal health needs each day.

Wellth member uses the app to submit a glucometer reading.

Principles of behavioral science and economics are found throughout the application and member experience to drive sustainable healthy habits over time. Leveraging concepts like social proof, the messenger effect, and the mere exposure effect, Wellth empowers members to better understand and engage in more and more healthy behaviors over time. 

By following the correlation between health outcomes and member behaviors, Wellth directly impacts half of Star Ratings measures with particularly strong results in triple-weighted medication adherence measures. In compliance with CMS guidelines, Wellth incentivizes health behaviors such as checking blood glucose levels and blood pressure or eating a healthy meal in tandem with a medication task. Combining the behavior tasks benefits from a cue-routine-reward cycle helps members understand how regular medication adherence is improving their other metrics.

Wellth's approach differs significantly from standard rewards and incentives programs, providing one-time rewards for completing specific tasks like getting an A1c test. A single incentive for a single action fails to promote real behavioral change. While Wellth can drive significant improvements in outcomes and utilization in a matter of months, its program focuses on sustained engagement over 12 months and beyond to drive actual behavioral change. 

Using behavioral science strategies, Wellth develops and strengthens healthy behaviors over time, making these behaviors more resilient - and ultimately more intrinsically motivated - than typical approaches adopted in the market. 

Get to Know Your Beneficiaries 

In addition to supporting triple weighted measures and closing gaps in care, Wellth's daily engagement helps health plans gain insight (and accurate data) from members - in a judgment-free, in-app context. Recruiting a significant swath of a plan's membership, including those hard-to-reach, "disengaged" patients. 

In the 2024 Medicare Advantage and Part D Final Rule, CMS has added a health equity index (HEI) reward to the 2027 Star Rating program to incentivize plans to improve care for beneficiaries with social risk factors. The addition of HEI means that plans will need to place extra focus on their most vulnerable members. Likewise, NCQA updated 2023 HEDIS measures to include race and ethnicity data and gender-relevant care measures. NCQA also added a requirement for 2024 Special Needs Plans to screen for food, housing, and transportation needs. 

Collecting this critical data within a program that members use daily and trust, makes gathering feedback confirming contact information, and enquiring on social determinants of health much easier with little to no additional lift from health plans. Wellth specifically utilizes principles of behavioral science and machine learning AI to make it possible to time nudges for optimal responses based on members behaviors within the app.

Improving Plan Experience

The same low-friction survey experience captures responses to HRAs, mock CAHPS, and other validated instruments. This level of engagement helps plans front-run any issues with member experience, customer service, or complaints to preserve or, ideally, improve CMS Star Ratings. In addition, ongoing insights from your membership can improve retention and loyalty to the plan.

Prescription refill reminder example

Dr. Sarah Watters, Wellth's behavioral scientist, notes that "using behavioral science to prime topics and provide relevant talking points for members before their appointments helps to empower members to engage with their care teams and ultimately close gaps in care. In-app survey questions also allow members to give more honest responses than they likely would have in person, ultimately leading them to more appropriate care." 

In light of a recent survey from Retirement Living that indicated that just 44% of MA beneficiaries said they fully understand their plan, making beneficiaries aware of all their available benefits, something Wellth does during members' daily check-ins, has the potential to add significant value to their experience. 

Many Medicare Advantage plans go beyond the basic coverage of traditional Medicare by including comprehensive benefits such as prescription delivery and wellness programs. These benefits improve the quality of life for seniors and lead to better long-term outcomes and, ultimately, cost savings. But only when they're used. By connecting beneficiaries to these resources and benefits in a timely fashion - and surfacing those that might be most relevant to members - both the plans and beneficiaries win. 

To get more insight on Wellth's Medicare Advantage Star Ratings product  or see how Wellth can help meet your health plan's needs, contact us today.