CMS Emphasizes Member Experience in Star Ratings

by Jane Anderson

CMS, building on its multi-year theme of emphasizing member experience within Medicare Advantage (MA), is increasing the weight of member experience measures beginning with the 2021 star ratings.

"CMS is really emphasizing the patient experience and the patient's perception of their care, both from the plan and with the plan's provider network," says Melissa Smith, senior vice president, stars and strategy for Gorman Health Group. "[T]his is the first time that we're really disproportionately going to see [patient experience] weigh on stars."

With the changes, 32% of the star rating will represent member perceptions, Smith tells AIS Health.

"This has been coming for a while, and plans — particularly the more thoughtful and progressive plans that are out there — really have started to make this a way of doing business," adds Matt Siegel, specialist leader, Deloitte LLP.

CMS now will emphasize measures in which many plans historically have struggled, Smith says. In fact, the two areas in which plans struggle most are the Consumer Assessment of Healthcare Providers & Systems (CAHPS) and the Health Outcomes Survey, and beginning in 2021, those two surveys will be worth a combined 41% of the overall rating, Smith says.

To prepare for this changes, MA plans will need to "take a very hard look at what they're selling, how they're packaging it and communicating it to the consumer, and then how effectively they’re acting upon what they promised the consumer they’re going to get," Smith says.

To succeed in the new member experience-weighted star system, MA plans will need to consider star ratings and member experience in almost every aspect of their organizations, and incentivize, manage and measure staff performance, Siegel adds.

Akhil Rao, manager at Deloitte Consulting, says he expects "a seismic shift in how plans will be impacted." Some plans are doing well in the CAHPS survey, and many of those also are 5-star plans. Those could continue to perform well once CAHPS results make up a far larger percentage of their overall stars rating, he adds.

From RADAR on Medicare Advantage