Value-based care is gaining traction in the healthcare industry. This means companies like the Centers for Medicare & Medicaid Services (CMS) are working to make sure care providers are rated and held accountable for the value of the care they provide. One of the key rating systems they have created is the Quality of Patient Care (QoPC) Stars Rating or Stars Rating

The CMS updates the standards quarterly. They are updated to help further ensure patient safety and quality of care are accurately represented to the customers. The ratings are on a  scale from one star to five stars. A one-star rating represents care that is significantly below average and a five-star rating represents care that is significantly above average. 

This article will take a deep dive into the measures of the Stars Rating and potential ways that insurance providers can increase their own Stars ratings. Medicare Advantage (MA) providers need to stay up to date on the Stars Rating criteria and work actively to maximize their scores. 

Medicare Advantage Health Plans

Medicare Advantage Plans, also known as Medicare Part C or MA plans, and Medicare Part D plans are the only types of plans specifically rated by the Centers for Medicare & Medicaid Services. The ratings are in place to help ensure patient safety, allowing consumers to compare providers in order to select a plan that fits their needs and budgets. 

Part C and Part D plans are similar, only Part D plans offer prescription drug plans. There are a few extra quality measures that a Part D plan must meet in comparison to Part C plans. Handling complaints and service requests is a measure for both plans. Keeping a tight handle on response times for complaint tickets is a key factor in providing five-star service. 

Including a service like Peerfit Move could be an instant boost to this measure. With an average response time of 3 hours, and 82% of those tickets being responded to in less than an hour, customers will rest easy knowing their complaints are heard and handled with care. The average resolution time on tickets with Peerfit move is 15 hours. 

Keeping response and resolution times quick and efficient will help increase a provider’s score in one of the most valued measures in the eyes of CMS. Putting patients first is a key component to raising all of the ratings CMS uses to grade providers. The Stars Rating is widely regarded as a reliable metric for predicting the scores of other ratings like HOS scores, HEDIS scores, and CAHPS ratings. 

CMS Stars Rating Measures

There are a number of measures the CMS uses to rate the care given to Medicare users. Recently, the scoring has shifted to put significantly more weight on patient experience. This means customer service and response times are of utmost importance for providers looking to improve their ratings. 

MA plans including prescription drug services are rated on up to 38 quality and performance measures. Those without prescription drug plans are rated on up to 28 unique measures. These include everything from annual flu vaccines to customer service. There are a few measures Medicare providers can use to raise their ratings quickly, including: 

  • Timely decisions about appeals
  • Customer service
  • Complaints about the plan
  • Call Center – Foreign language interpreter and TTY availability
  • Reviewing appeals decisions

The measures above are all things that can have a significant impact on a Stars Rating. Providing services that put customers first will have a significant positive impact on your Stars rating and other important scores like CAHPS and HEDIS.

Incorporating a service like Peerfit Move, for example, can help raise your Stars rating simply due to a swift and efficient approach to customer service. With a 98% customer satisfaction rating, PeerFit Move can be an instant boost to Stars Rating. Combined with an average hold time of less than 32 seconds on service calls, services like Peerfit Move can significantly help your plan in the eyes of the CMS Stars Rating. 

Improving Patient Experience

As of 2020, the CMS changed its methodology for determining its Star Ratings. The changes imply that customer-experience-focused metrics will account for over 50% of the Stars Rating scores. Improving patient experience is the backbone of value-based care and the Stars Rating system is doing all it can to facilitate that notion.

CMS is putting more emphasis on the consumer assessment of healthcare they receive. This means incorporating services that put customers first should be at the top of any insurance provider’s to-do list, especially Medicare providers. 

One specific measure CMS considers when giving out their Stars ratings is the quality of a service’s call center. Handling calls efficiently can be a major increase in a provider’s rating. Peerfit Move is a great example of call center efficiency, with 92% of calls being resolved on the first call. 

Being aware and considerate of a customer's time will help leave a positive image of your services in the eyes of the consumer. When they are surveyed annually, they are likely to remember the ease of the call and the efficiency with which their issue was handled. These surveys are the main component of how the CMS generates its Stars Rating for each individual provider.

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