Now Is the Time for Medicare Advantage Plans to Re-align the Stars

A computer screen depicting how beneficiaries rate their Medicare Advantage plans based on number of stars

So much of last month’s 4th Annual Medicare Advantage Leadership Innovations conference agenda focused on member experience. We all know why: Two years from now, member experience (CAHPS) and administrative measures will account for more than half of CMS Star Ratings.

CMS has steadily increased the weight of member experience dating back to 2019. Soon, it alone will represent nearly one-third of plans’ overall Star Ratings.

How can Medicare Advantage (MA) plans prepare for this new reality? The Medicare Advantage Leadership Innovations conference made three things clear:

  1. Member engagement is the hub around which member experience success is built.
  2. Don’t underestimate the tech-savviness of today’s MA members.
  3. There’s no time to waste.

Close the Gap for Stronger Engagement

Teledoc’s session at the conference spoke to the changing digital landscape for MA members. Was I the only one surprised to learn that the majority of today’s enrollees were still in the workforce when the iPhone was released in 2007?

The pandemic has more seniors in general turning to digital in the absence of personal interactions. They’re also looking to their health plans more than ever, thus creating a huge opportunity to enhance engagement and experience.

Member-facing technology solutions can play a role in everything from quickly getting necessary care, to conducting the appointments themselves, to finding the lowest-cost therapies afterward. (Keeping in mind their varying digital comfort levels, a multi-channel approach is still imperative so that no one is left behind.)

Technologies that bridge the gap and create efficiencies for members and plans alike give plans a leg up now, and as 2023 approaches.

Putting Prescription Drug Benefits to the Test

How would the majority of your MA members answer these CAHPS survey questions today?

  • In the last 6 months, did you delay or not fill a prescription because you felt you could not afford it?
  • In the last 6 months, how often was it easy to get the medicine your doctor prescribed?
  • In the last 6 months, how often did you and your personal doctor talk about all the prescription medicines you were taking?

Considering Star Ratings, any MA plan might be nervous about how their population answers, especially given some recent survey findings published in Becker Hospital Review:

  • 36% of patients have forgone medications to pay for essential items and bills
  • 43% have forgone paying essential items and bills in order to afford medications
  • 41% have skipped or altered doses to make prescriptions last longer

Rx Savings Solutions’ own 2020 consumer survey found that 67% of respondents felt they had no control over their prescription costs. All of which speak to the impetus behind CMS’s forthcoming rule requiring beneficiary real-time benefit tools (RTBTs).

At the Leadership Innovations conference, Rx Savings Solutions CEO Michael Rea sat on a panel discussing benefits that have actuarily demonstrated cost savings. As you might expect, our solution came up as one of the examples. It checks all the required boxes for a member-facing RTBT and supports initiatives aimed directly at the newly weighted Star measures:

  • Communicating clinically appropriate, easy-to-understand and on-formulary alternatives
  • Increasing adherence by navigating members to options they can afford
  • Eliminating barriers to switching (improving access) to lower-cost prescription options

Everyone wants more engaged MA members who will rate their experiences more favorably. Many of the plans I talk with have initiatives either planned or under way, but very few are confident in their preparation for CMS-4190 or the changes in weighted Star measures.

Each day is one day closer to Jan. 1, 2023, and every day is an opportunity to implement a member-facing solution that both meets mandates and makes for happier members.



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