The Star Health Plan Ratings are constructed to help the 203 million people that are enroll in health plans. The Healthcare Effectiveness Data and Information Set, also known as HEDIS®, are determined by NCQA to make sure that preventive measures are performed by the providers. Plans are rated on a 0–5 stars scale. Six out of 1,048 health plans that earned a numerical rating achieved 5 stars, the highest possible rating.
The ratings are released by NCQA at the end of each year. “With open enrollment for health plans beginning in November, the NCQA 2022 Health Plan Ratings provide timely insight to help consumers and businesses make informed decisions about their health care,” said NCQA President Margaret E. O’Kane. “NCQA was founded as an independent nonprofit in 1990 to ‘turn on the lights’ by measuring and holding health plans accountable for health care quality. With the 2022 ratings, we’re proud to spotlight top performers and identify ways to improve health care quality, access and equity.”
These strong ratings unveiled the maximum available quality bonus payment and rebates to fund benefits for members and providers. More importantly, the impressive 5-Star rating allows all of the plans that achieved that number to market their products throughout the entire year, providing them with a strong local competitive lead as Medicare Advantage plans seek to attract a strong share of the 10,000 baby boomers aging into Medicare every day.
Today almost 70% of all Medicare Advantage plans are at 4 or more Stars, providing quality bonus payments to almost 90% of all eligible beneficiaries. This means that only 30% of plans are now under 4 Stars, compared to 50% last year. To review the score card visit https://reportcards.ncqa.org/health-plans
Heath Plans and NCQA are getting serious about CAHPS. The theme in Medicare Advantage throughout 2023 is going to be “CAHPS, CAHPS, CAHPS, CAHPS” all across the country. Next year is going to be one of the HEDIS® that matter the most. As we head towards the new benefit year, providers would have to make sure they pleased the patients in a more unique way to avoid unpleasant surprises. The interaction with physicians and staff is crucial to create relationships that would dodge negative feedback, the use of software’s in order to report patient experience can also be the guarantee for success when it comes to CAHPS, platforms like Ensure Data Solutions www.ensuredatasolutios.com allow organizations to keep track of complains and expose the patients to questions related to customer satisfaction. Phone calls to members could play a role in next year Star Ratings, especially now that CAPHS surveys are driving more than 1/3 of the Star Rating.
When it comes to cost for improvement CAHPS is creating a new need for providers, they would have to invest in phone calls or home visits to improve patient’s satisfaction. A way to internaly keep track of patient’s feedback would also help improve the organization and adjust to what the patient expects every time they visit a medical center. Ensure Data Solutions “Service Assessment” module enable tracking and reporting, not only to collect patients’ feedback, but also to see how staff is addressing complains, investing on a platform like Ensure could have a very high ROI considering the importance of CAHPS for next year.