|
As CMS resumed normal Star
Ratings calculations and gave greater weight to patient experience measures,
the proportion of Medicare Advantage Prescription Drug (MA-PD) plans earning
4 stars or higher for 2023 saw a dramatic drop from 2022, according to newly released
CMS data. In a two-part series, top
performers outlined to AIS Health their strategies for success, such as
connecting the dots around medication adherence, helping members utilize
their benefits, and navigating member outreach without creating message
fatigue.
Highmark touts plan
variety, strong provider networks
- “We didn’t take
our foot off the gas during COVID and we’re continuing to drive
incremental improvements,” says William Rayball, vice president of
government quality with Highmark Health. According to AIS’s Directory
of Health Plans, approximately 75% of current Highmark
enrollees are estimated to be in 5-star plans next year, with the
remaining 25% in 4-star plans.
- Referring to
Highmark’s overall member satisfaction and experience approach, Rayball
tells AIS Health: “We’ve done a lot of incremental improvements in our
strategy to ensure that we are speaking to our members with one voice
when sequencing our communications. So we’re establishing more of a
dialogue with members rather than just pummeling them with fragmented
information.”
- Highmark
credits having an array of products across its markets “that are meeting
members where they’re at, whether that’s with supplemental benefits or a
variety of premium price points” with achieving member satisfaction.
“And certainly, our provider networks are designed in such a way that we
have an offering of plans that meet a wide variety of needs,” adds
Rayball. “And when members choose the plan that’s best suited for them,
that’s a driver of satisfaction.”
SCAN ‘minimizes
disruption,’ focuses on equity
- SCAN Health
Plan, meanwhile, prides itself on benefit stability, which President and
CEO Sachin Jain, M.D., says helped the California-based not-for-profit
insurer retain a 4.5-star rating for the sixth consecutive year.
- “In this
industry, there’s a lot of gimmicky stuff that [companies] do to get
people to buy their [plans]. You hear about oversized dental budgets or
very specific benefits that are only going to be in place for a year,
[and] that kind of stuff ends up ultimately jerking people around,”
remarks Jain. “One of our core principles, even when it works against
us, is to maintain that benefit stability and minimize disruption
because our family members are literally on this plan. And that’s not
how most plans work.”
- Jain also
points to SCAN’s increased focus on disparities and a comprehensive
strategy that began in 2020 to reduce a racial/ethnic gap in adherence
for cholesterol-lowing statins and diabetes drugs. “Medication adherence
measures are a really important part of clinical Star Ratings, and the
fact that we did emphasize reducing disparities in the African American
and Hispanic population members ultimately closed gaps for us that historically
were harder to close,” says Jain. “So I think focusing on specific
populations that are at risk for lower satisfaction rates for a clinical
performance is a part of our overall strategy.”
|
No comments:
Post a Comment