The Centers of Medicare & Medicaid Services (CMS) created the Five-Star Quality Rating System to drive improvements in Medicare quality and to help consumers and caregivers easily compare the performance of Medicare Advantage (MA) plans. Ratings emphasize patient care and satisfaction, health outcomes, and patient or member feedback.
Member experience has been growing in influence over how STAR categories are calculated. In part, it’s the result of CMS Ratings weighing health outcomes and member or patient satisfaction over plan operations. CMS is set to add more parameters to intensify the momentum to drive better quality, health outcomes and reduce costs. For example, CMS announced an increase in the weight of patient experience/complaints and access measures from 1.5 to 2, reflecting their commitment to put patients first.
Star Ratings can have a profound financial impact on health plans. Studies show that a one-star rating improvement could, on average, lead to an 8 percent to 12 percent annual increase in member enrollment. Moving from 3 stars to 4 could increase revenue between 13.4 percent and 17.6 percent through increased member enrollment.
The results are published for customers to compare and select plans. With 53 measures of quality and the customer experience, the rating system has been cited as a key strategy for health plans in retaining and expanding their customer base because higher star ratings typically attract more Medicare beneficiaries.
Plan members provide much of the data that determines whether a plan achieves high marks by answering standardized surveys. Potential enrollees can then use these results to make decisions about their health plan. Ratings cover five domains gauging how well MA plans care for their members based on a subset of the HEDIS measures, a standardized set of metrics designed to assess clinical quality, service utilization, and patient experiences.
MA plans can leverage Advance Care Planning (ACP) as a tool to increase their Star Rating by engaging their seriously ill members in care planning that allows them to share their care goals and preferences with healthcare providers and loved ones in a concise and meaningful format.
Why Advance Care Planning?
Data and research have shown that individuals with one or more chronic or serious illnesses are overwhelmingly unprepared to deal with the advance care planning that may arise as their illness progresses. Being unprepared can lead to the use of unwanted, unnecessary or non-beneficial treatments, potentially leading to undesired outcomes, and additional stress on family and caregivers leading to a poor healthcare experience.
Advance care planning supports individuals in understanding, and sharing their values, goals and preferences for future medical care. These care decisions are then formally documented within an Advance Directive, a legal document that empowers individuals, their loved ones and their care teams to make the right advance care planning in the event of a medical crisis or if the member is unable to speak for themselves.
ACP is shown to improve the experience of care and decrease unnecessary care utilization while helping individuals understand and communicate their personal care goals. Utilizing a scalable advance care planning solution can help plans drive more person-centered care by empowering members with future healthcare decision making.
Proactively Engage Members in Future Care Choices
Plans can support a good member experience by helping members feel empowered and connected to participate in their own medical care decisions through advance care planning. ACP allows members to manage their unique care goals, ask informed questions about treatment options and advocate for themselves if a time comes that they are not able to do so. Personalized ACP facilitations can help members feel like their health plan is genuinely looking out for their future care, which can improve the plan’s reputation and generate better member experiences, ultimately translating into higher Star Ratings.
Services that are person-centered such as advance care planning empower individuals who receive long-term care services to reach their goals and achieve a better quality of life. Using a tailored ACP approach to manage the seriously ill member populations can increase performance scores on experience and quality measures because plans will be able to more appropriately and effectively deliver future care, caregiver resources, and treatment interventions.
Improve Access to ACP with Technology
Plans can improve member access to advance care planning through the use of our technology enabled services instead of relying solely on in-person visits performed by clinical teams. Not only is this beneficial in reducing the utilization cost in the network, but could also be easier for members. By adopting technology enabled platforms, plans can facilitate universal access to advance care planning to a broad member population. From fully facilitated expert-led conversations to self-service solutions, members can complete and share advance directives easier than ever before.
Iris’ team of specially trained ACP experts provide phone or video consultations when it’s convenient (i.e., daytime, evening or weekends) for seriously ill members and their family to facilitate highly individualized care planning discussions, provide disease specific education and document care goals and preferences. Our facilitators also address symptoms and other medical care needs, help uncover social determinants of health, and needs of caregivers. This approach enables better care coordination, enhances the member experience and improves healthcare outcomes.
Baby boomers who are now starting to enter into MA programs have a more flexible attitude about health, wellness and have a track record of embracing technology and innovation, especially when it comes to managing their health. As early adopters of devices like personal computers, cell phones and fitness trackers, this group is adjusted to using technology to manage their health and well-being. By utilizing self-guided online platforms, plans can enable their healthier populations to engage in healthcare decision-making early on in their medical journey to ensure that they receive care that aligns with their values and goals. This will help individuals retain control of their healthcare and avoid unwanted, non-beneficial care.
Partnering with Iris for Advance Care Planning
Iris offers a comprehensive suite of Advance Care Planning solutions delivered with expert guidance and cutting edge technology to scale the delivery of Advance Care Planning for the seriously ill and healthier populations. Our solutions guide members through the full lifecycle of advance care planning including creation, signing, and distribution of documents to care teams and loved ones.
This creates a supportive process for members while also reducing the time-intensive burden of ACP discussions for provider physicians and complex planning and execution on internal payor resources. Iris takes ownership of the integration and delivery of Advance Care Planning and expanding access to Palliative Care and Hospice while keeping your clinical teams informed.
Iris ACP solutions enable plans to go beyond traditional, payer-centered options to empower providers and members to collaboratively work through shared challenges of end-of-life care decision making to improve health outcomes and the member experience. Our solutions result in reduced care utilization, lower cost of care, improved healthcare quality and enhanced member experience, all metrics that can positively impact a plan’s Star Ratings. Contact us today to learn more about our ACP solutions.