![]() Standardizing the onboarding process ensures that patients are fully informed about everything from networks and providers to prescription benefits. Onboarding is a crucial time for payers to help patients understand their benefits and how they can maximize the available plan resources to maintain or improve their health. Standardize the onboarding process for new plan participants ![]() That’s a win for everyone, including providers, payers, and patients. New VBC opportunities allow payers to structure financial incentives that further motivate providers and payers to innovate and continue improving patient experience. Today, value-based care (VBC) contracts often stipulate what quality scores providers must achieve. One of the most important metrics for achieving HEDIS success is partnering with providers who are committed to closing care gaps to improve patient satisfaction and care quality. HEDIS metrics are identified and updated by the National Committee for Quality Assurance (NCQA) and provide the most effective standardized metrics for comparing health plan performance. However, when it comes to the patient experience, the providers do most of the day-to-day work to move the needle on Healthcare Effectiveness Data and Information Set (HEDIS) measures. There are several strategies payers can use to improve patient satisfaction and increase CMS star ratings. Create effective payer-provider partnerships These strategies can help payers engage plan participants, improve patient relations, and target important quality metrics. To achieve higher star ratings, payers must understand which CAHPS measures to target for maximum impact. Five strategies for improving CAHPS scores through better patient experience Payers who focus on patient experience scores-while maintaining or improving quality and performance metrics-can see a positive shift in their total Medicare star rating. Last year, CMS announced that patient experience scores will be quadruple weighted, accounting for 32% of total plan scores. The benefit of this approach is that plans cannot simply maintain their current performance level from year to year-they must continuously improve.Ĭhanges implemented in 2021 present an opportunity for MA plans to boost star ratings in 2022. Increasing CMS star ratings by improving patient experience and CAHPS scores: challenges and opportunitiesĮach year, CMS reviews CAHPS scores and star ratings data and adjusts plan performance metrics according to how plans performed in the prior year. A higher star rating also makes plans eligible for higher quality bonus payment (QBP) reimbursements, which totaled $11.6 billion in 2021. Achieving a higher star rating indicates better quality, lower plan costs, or both and can help payers attract new plan participants. They objectively assess plan value and performance to help consumers find the plans that offer the best value. Payer CMS star ratings include scores for Medicare Advantage (Parts A and B) and prescription (Part D) benefits. Lead to higher per-member-per-month (PMPM) rates from Medicare higher performance yields higher PMPM, thereby directly affecting revenue.Give plans the ability to differentiate and attract new participants.Provide a standardized tool for CMS to measure the quality of all Medicare Advantage plans and prescription drug plans.Healthcare was a little slower than some other industries to adopt star ratings as a comparison tool, but today, they are critically important for Medicare consumers who want to evaluate insurance plan choices. Payers have a great opportunity to focus on patient satisfaction and improve their CMS star ratings in 2022 and beyond. This system allows consumers to compare health plans on a range of metrics for quality, performance, network benefits, costs, and patient experience.īeginning in 2021, patient experience scores quadrupled weight in the overall Medicare star rating calculations for payers. But that is not the only way CMS uses CAHPS surveys.ĬMS also uses CAHPS scores to calculate a star rating for Medicare Advantage (MA) plans. ![]() Many people are familiar with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores that the Centers for Medicare and Medicaid Services (CMS) uses to publish star ratings for hospitals, nursing home facilities, home health, and outpatient surgery centers. How CAHPS scores influence more than just CMS star ratings
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