How Can Medicare Advantage Plans Achieve and Maintain High Star Ratings?

Published on September 26, 2019

Medicare Star Ratings shape consumer perceptions of health plans and directly impact insurers’ profitability. Like a Yelp or Amazon review score, a plan’s Star Rating can attract, retain or turn away consumers, affecting the organization’s reputation, brand and even its market share.

Whether you’re an administrator or healthcare marketer, you already know that achieving and maintaining exceptional Star Rating performance is becoming increasingly difficult. And you likely already know why: rising CMS standards, higher consumer expectations and an emphasis on scores in categories that can seem ambiguous, like member experience.

Instead of feeling frustrated or challenged by this, you can learn how to thrive. Carrot Health’s latest white paper – “Leveraging Data to Boost Star Rating Performance: Three Steps to Building and Operating an Exceptional Program” – details how to use data to develop, track and implement comprehensive programs that meet and exceed member expectations, while also hitting specific thresholds that affect Star Ratings. It outlines actions health plans can take to achieve and maintain high Star Ratings, including:

  • Conduct a data-driven assessment of member and provider performance.
  • Identify common roadblocks to achieving better Star Rating scores.
  • Face the data problems – quality, timeliness, accessibility, etc. – in your organization.
  • Get beyond the basics of compliance to understand your members.

Specifically, our latest white paper explains three data-driven steps that promise to revolutionize the performance of any health plan:

  1. Optimize member engagement. / To help you become more sophisticated and nuanced in your approach, we share sample member profiles built using Carrot Marketview. These profiles combine eligibility, claims, medical adherence and survey data, and they reflect individualized information on compliance, tendencies and timing of care needs. This data leads to actionable insights and predictive models that inform member engagement opportunities.
  • Optimize provider alignment. / Health plans are dependent on provider partners to ensure service, quality, experience and health outcomes for their members. In this white paper, we offer examples of Carrot Marketview’s provider scorecards, which health plans can use to identify and calculate provider engagement opportunities.
  • Measure quantitative and qualitative outcomes. / Health plans can also use Carrot Marketview to measure the impact and ROI of outreach and engagement in great detail. For example, marketing and clinical data can help the plan determine which members responded to calls or mailers, who became compliant and who was responsive to provider engagement.

Plans improve their Star Rating performance when they are able to turn data into actionable insights. Get the paper to better understand how this level of precision data and performance enhancement equips you to hit critical cut-points that are essential for optimal reimbursement – even as CMS standard levels, consumer expectations and the level of competition continues to rise.

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