How to Improve Medicare Star Ratings Using Data Insights

By Jacob Luria, President at N1 Health, Nick Kamireddy, Senior Director, Strategic Partnerships at Arcadia 

Medicare Star Ratings play a crucial role in assessing the quality and performance of health plans. Improving your Star Ratings means enhancing the quality of care you provide to members, increasing engagement, and driving better outcomes.

A data-driven approach is paramount to this endeavor because it provides the context necessary to identify performance gaps, deliver personalized members experiences to rectify them, and monitor your progress over time. Let’s explore how you can harness data to improve your payer Star Ratings and the overall member experience.

Identify performance gaps and opportunities through personalization

Health plans have tremendous amounts of data that are available to drive member Star gains. Use data analysis tools to identify patterns or outliers that indicate opportunities for improvement. Extract insights from healthcare data such as:

  • Claims data: Analyze patterns in care utilization and delivery through performance metrics such as readmission rates and length of stay. Then, plan personalized improvement by tailoring treatment plans to identified individual risk profiles.
  • Electronic health records (EHR): Use clinical data, including treatment plans and outcomes, to track member progress over time. With this EHR data, you can develop customized treatment plans to accommodate individual member needs based on their clinical history.
  • Member satisfaction surveys: Identify ways to improve the member experience based on their direct feedback through satisfaction surveys. The specific concerns or preferences raised in these surveys may provide clear opportunities for improvement.
  • Benefit utilization: Track the use of health insurance benefits, such as diagnostic tests and specialist visits, to understand member adherence to recommended services. Based on any patterns identified, develop a plan to proactively address member health priorities through preventive screenings or services and education programs.
  • Engagement and touchpoint histories: Touchpoint history across various channels, such as telehealth consultations or a member portal on your website, can reveal important engagement data to guide future member outreach efforts. Implement this data into your member communications plan to craft outreach around their habits and preferences.
  • External consumer data: Gain a comprehensive understanding of members’ needs and preferences by integrating external consumer information with health data. These insights into their lifestyles and behaviors outside the healthcare system can help you address social determinants of health (SDoH) and tailor health promotion efforts to individual needs.

Analyze this data to not only identify gaps in preventative care services, disease management, and other offerings, but also reach members where they are.

Target interventions based on data analysis

Data analysis empowers providers to plan their approach to personalized care — but to improve your Star Ratings, you must act on the insights gathered from your analysis. After identifying performance gaps and member needs, target key interventions such as:

  • Care management programs: Using data about high-risk members and complex health needs, work with providers to implement care management programs by assigning care coordinators to monitor members’ health statuses and educate members in need. Arcadia recommends using dedicated care management software to support cohort identification, resource allocation, and impact measurement.
  • Preventive care initiatives: Promote preventive care measures, such as immunizations and health screenings, and use benefit utilization data to target your outreach. This might include feedback mechanisms like member reminders to ensure they are notified and aware of relevant preventive care services.
  • Medication adherence campaigns: Improve member adherence to prescribed medications by educating and reminding members about the importance of adhering to their recommended medication regimen. Use pharmacy refill data and member self-reports to identify members at risk of non-adherence and offer medication counseling and other support programs to encourage adherence.
  • Chronic disease management programs: Identify members with chronic conditions who are not meeting quality benchmarks and plan interventions to support improved outcomes. Offer member self-management tools, remote monitoring devices, and other resources to go a step beyond personalized care plans and empower members to actively manage their long-term health conditions.
  • Benefit Utilization Campaigns: Offer members specific benefits related to their personas to increase likelihood of positive, value-add encounters so drive higher plan experience scores. Using consumer data allows for personalized offers that drive member satisfaction.

Additional data, such as digital personas that are aligned to benefits, help predict the best content and channels for campaign communications. For example, you may tailor content to resonate with a specific persona’s health needs and concerns. Then, deliver this content via a channel that this persona is active on based on member engagement and touchpoint histories.

Monitor Star Ratings over time

Improving your Star Ratings is important for delivering the highest quality of care possible, which directly impacts enrollment, retention, and reimbursements. However, you must sustain these gains over time to deliver high-quality care and maintain a competitive edge.

To do so, facilitate continuous monitoring of your Star Ratings and the factors impacting it. Healthcare payer analytics solutions are invaluable tools that support this process through the following capabilities:

  • Data integration and aggregation: By centralizing data across various sources, payer analytics solutions provide a comprehensive view of performance data relevant to Star Ratings. This way, you can analyze your performance from every angle and benchmark your performance against industry standards.
  • Predictive analytics: High-risk members are most likely to impact Star Ratings. Payer analytics solutions can identify these members and help providers proactively target interventions to prioritize care management efforts for high-risk populations.
  • Workflow optimization: Healthcare payer analytics solutions can identify opportunities to streamline workflows, such as reducing administrative processes and enhancing care coordination. These process improvements allow you to make better-informed care decisions, enhancing the overall quality of care provided.

Regularly monitoring your Star Ratings also empowers you to adapt to changing healthcare conditions as necessary to meet evolving member needs and industry standards. Data insights from an extended period can help you identify long-term trends and patterns affecting care and engagement. This way, you can predict individual members’ needs to connect with the non-engaged.

Data is the backbone of informed decision making in member care and engagement. Meaningful improvements to your processes and care delivery will be reflected in your Star Ratings, making it a focal point for measuring enhancements to your quality of care. Invite feedback from members to prioritize their experience and drive improvements not only to your Star Ratings, but to their overall care experience.

N1 Health wins coveted KLAS Research Peak Award for Innovative, Scaled Use Cases

N1 Health was pleased to present two Points of Light case studies with great partners Tyler Creager Traci Massie in Salt Lake City this week with our efforts earning the K2 Peak Award.

These case studies represent the best of personalization in health care – increasing member engagement to primary care, creating stable revenue growth for key product lines, and adding abilities for care givers to meet members where they are. This award demonstrates how campaigns of 150,000 member campaigns can be personalized and earn tremendous business results.

“I congratulate the newest winners of the K2 Peak Award for outstanding payer-provider collaboration. This recognition serves as a testament to the remarkable possibilities that emerge when healthcare executives and their partners unite with a shared goal of enhancing healthcare outcomes” – Adam Gale, CEO of KLAS.

Changes to Medicare Advantage Creating More Challenging Business Environment

While attending the Medicarians Conference in May 2024 it has become clear – Medicare Advantage is a more challenging business than in the years before.

N1 Health shared perspectives on how AI and personalization not only drives a better member experience – it does so with less cost to drive more effective outcomes. It is clear many plans are embracing this opportunity to rethink key business process and ways to meet their members where they are and others are not.

We believe that those who adopt the practices of successful consumer-driven organizations will be the winners of Medicare Advantage in the post 2024 world.



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