Decrease in Star Ratings Present Opportunities for Health Plan Quality Improvement

Data shows that there was an increase in star ratings from 2020 to 2022. This presented a promising statistic that during COVID, patients were still receiving high quality care. However, Star Ratings have decreased from 2022-2023 significantly. The 2023 rates came back down to Pre-COVID levels. This increase could have been due to the COVID exclusion methodology, and thus provided a fast positive impression.

While the 2023 Star Ratings are back to Pre-COVID levels, this presents an opportunity for health plans to improve.

There are 3 main strategies for health plans to evaluate:

1. Improve Cancer Screenings
2. Improve Member Satisfaction
3. Improve Access to Patient Records

It is vitally important to ensure members receive their preventive screenings, including colorectal and breast cancer screenings. Flu shots have been documented to prevent disease onset, ensuring that patients stay healthy. Preventive care ensures that disease is detected early or eliminated altogether, allowing for higher quality care and overall lower costs.

One major strategy to employ is to encourage primary care providers to complete Annual Wellness Visits. Many of the preventive quality metrics can be completed during the AWV, which is completed for the patient on an annual basis. Proper documentation of the completion of the quality metrics is also imperative. Unless the primary care provider (or other healthcare professional) documents these accurately, the health plan will have no way to know that these were completed.

Using technology to help alleviate both the process of completing the AWV and proper quality metric documentation. AaNeel provides a technology platform that identifies care gaps for patients. Additionally, our Annex tool helps the provider see the care gaps right in their EHR—with single sign on capabilities, Annex extension works seamlessly in the EHR, so the provider doesn’t need to log into multiple systems to identify care gaps during an AWV (or any other visit).

Star ratings indicate a decrease in patient satisfaction- all six CAHPS measures looked at for health plans, fell by at least 0.59. At the same time, CMS has increased the weight of the CAHPS member satisfaction

Part C and D Performance Data | CMS

survey on Star Ratings from 2.5X in 2022 to 4.0X in 2023. Increasing the weight of the patient satisfaction survey, while the ratings are decreasing will have a profound impact on the star ratings.
One major strategy to employ to help increase member satisfaction is member engagement.

Using technology to help member engagement can be a key. AaNeel provides the ability for health plans to share data with their members with SMART on FHIR technology. The member portal allows the patient to have access to all their health data; our member card is a digital health card with similar capabilities, which increases patient engagement and empowers the patient.

Based on the latest data, members are switching health plans at a significantly higher rate than previously. Members that switched plans increased by almost 2.5 percentage points between 2022 and 2023 to 17.15%. This trend will cost payers, as it takes approximately four years to recoup the cost. While health plans can’t directly control member attrition rates, member satisfaction will go a long way towards ensuring patients stay in the same plan.

However, there will always be some level of churn. If a patient does move between plans, it’s important for the new plan to have access to the patient’s historic health data to ensure they can be proactive about patient health management. Specifically, it’s important to ensure that the patients are enrolled in appropriate care and case management programs, or their quality metrics are up to date. Data exchange between health plans will go a long way in helping to improve access to patient records. While the health plan and patient benefit from having access to their data, it is important that this data actually makes it to the provider, for improved care coordination.

Similar to the patient engagement strategy, if a member switches health plans, AaNeel has the capability to complete data exchange between health plans with the SMART on FHIR technology—as long as both health plans are amenable to the data exchange. This allows the new health plan to understand the members’ needs and improve care coordination.

In order for the quality of care to truly be impacted and improved, patients, providers, and health plans must come together. It will truly take a collaborative effort, data transparency, and improved care coordination for the quality of care to increase. Technology will play a critical role in quality improvement, and it is important to find the right technology partner to bring together patients, providers, and health plans.