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Optimize Star Ratings in the Medicare Advantage Market: 3 Strategies for Payers

As health plans flood the Medicare Advantage (MA) market, it is increasingly challenging for payers to compete.

In this competitive environment, the Center for Medicare and Medicaid’s (CMS) Five-Star Quality Rating System is now more important than ever when it comes to proving value.

Used as a benchmark for prospective members, these ratings are key in plan comparison and, ultimately, decision, with higher scores driving recruitment and revenue.

Incremental shifts in ratings have both benefits and consequences, with a one-star improvement increasing enrollment up to 12 percent annually and a half-star decrease resulting in a revenue decrease of nearly 23%.

If you’re a payer aiming to improve star ratings this year, read on.

Below, we share three strategies for elevated star ratings in the MA market.

Collaborate with Providers

While payers don’t have control over payer day-to-day activities, establishing open communication around completion of tasks associated with star ratings is a must.

To foster collaboration, payers must:

  • Employ standardized measurement tools and strategies
  • Incorporate tools to integrate data between all entities
  • Align clinical goals

By collaborating across a variety of channels, payers and providers can better align, yielding a more cohesive plan for working toward higher star ratings.

Make Your Data Work as Hard as You Do

While collecting data is a step to improved ratings, actioning data is the path.

By analyzing data, you can build strategies around quality-focused improvement.

Data-driven actions payers should take to improve ratings include:

  • Assess member and provider performance
  • Identify roadblocks impeding higher star ratings
  • Determine data challenges facing your organization

By mining your data for insights into these three areas, you can assess and adjust practices and process to meet CMS standards and consumer expectations, achieving increased alignment with the CMS Five-Star Quality Rating System.

Ready for a Value-Based Tomorrow

As healthcare as a whole continues to transition to a value-based model, it is inevitable that the star ratings shift toward outcome metrics.

For proactive payers, prioritizing this coming shift through employing analytics capable of predicting performance and outcomes will ensure future success.

While CMS will continue to tailor the requirements of the star ratings to mirror the evolving realities of healthcare, enacting these three strategies will presently and proactively enable payers to meet upper-echelon criteria, ensuring success today and tomorrow.

Click here to learn more about how Collective Medical, a PointClickCare company, supports payer and provider collaboration!