The Five-Star Quality Rating System is an important strategic tool of the Centers for Medicare and Medicaid Services (CMS) to measure and rate a plan’s quality and performance.1 While there are a lot of uncertainties in the health care market, and the Medicare Advantage market in particular, one thing is certain: Star Ratings are important to Medicare plans.
The Star Rating System helps inform Medicare enrollees as they compare health plans. Any plan rated four Stars or above receives quality bonuses from CMS. This further enhances a plan’s ability to add more benefits, services and resources to support their members’ health and well-being.
Moving away from traditional models
As more fee-for-service Medicare members are diagnosed with multiple conditions, the risk of fragmented care and limited communication between care providers and services increases. Historically, those models have been tracked by condition and lacked cohesion.
Traditional models aren’t meeting today’s need to share effective knowledge between clinicians and care providers for three or more different treatment plans. Health plans realize that it’s time for a holistic approach that positively impacts member engagement, compliance and satisfaction — and improve Star Ratings in the process.
From fragmentation to focus
The increase in comorbidities among Medicare Advantage members requires more focus on case management and coordinated care. Health plans that want to see a steady improvement in Star Ratings need to combine a high-touch model with strategically developed initiatives.
When the whole person is treated, health plans find that integrating care activities delivers the right services at the right time. Patients are visualized at the center of care instead of the focus being on the system.
High-touch care features multidisciplinary teams that work together to address a wide range of factors affecting a patient’s health. But first, it must become standard practice for quality measures to be identified across multiple disease states. Plans that transition from the one-and-done mentality to an ongoing approach to care will bring multifaceted and cost-effective care to patients who require it.
Improve health outcomes and care coordination
High-touch care isn’t necessarily about constant interaction between the patient and the provider. It also means care that’s delivered in the way that resonates with the patient. It means communication at the right time, with the right people, and providing safe, effective care to the patient. It’s care coordination at its finest.
The best care coordination navigates the often-disjointed landscape of current health care systems. It needs to be driven by primary care physicians and specialists, which is key to improving health care outcomes for patients. Coordination involves organizing care activities and sharing that information with the care team.
Health plans can collaborate closely with care providers to support patient access and health through:
- Data sharing
- Year-round electronic chart collection
- Quality incentives
- Field-based practice resources
It’s vital to deliver a personalized experience that helps Medicare members and their caregivers more easily navigate health care. Doing this requires removing barriers that might otherwise be a burden as patients seek to manage their complex health needs, complete recommended preventive care and make the most of their health.
Take the holistic approach to improve quality health care outcomes
Each day, 10,000 people are aging into Medicare, and chronic diseases remain a major challenge for this aging population.2 With multiple conditions affecting a large number of them, it’s imperative to treat the whole person. A holistic approach to managing multiple comorbidities and chronic diseases aids in reducing acute care episodes.
- Using high-touch care models to help encompass the whole person. HouseCalls provides patients with the choice of receiving a yearly clinical wellness visit from the comfort of home.
- Conducting preventive screenings, offering a way to proactively identify issues in the early stages and possibly reduce hospitalizations.
- Addressing patients’ social determinants of health and understanding their cultural and social environments helps health care providers coach them and effect behavioral change. With HouseCalls, clinicians can see patients in their natural environments.
Proving your high-quality plan with Stars
As the Medicare Advantage market continues to grow and mature, points of differentiation between health plans continue to narrow. Medicare Star Ratings are one of the most effective ways to differentiate your plan in the market because they verify that your organization provides high-quality care.
It’s more important than ever for health plans to proactively manage their Star performance measures in order to improve and achieve a four-star rating and beyond. It starts by putting patients at the center of care.
To learn more about improving Star Ratings through high-touch strategies, visit optum.com/housecalls or read the full article.
1. Medicare.gov. 5-star special enrollment period. medicare.gov/sign-upchange-plans/when-can-i-join-a-health-or-drug-plan/5- star-special-enrollment-period. Accessed October 13, 2022.
2. Centers for Medicare & Medicaid Services. CMS announces new streamlined user experience for Medicare beneficiaries. cms.gov/ newsroom/press-releases/cms-announces-new-streamlined-user-experience-medicare-beneficiaries. October 1, 2018. Accessed October 13, 2022.