Surveys, Advanced Analytics Key for Member Experience, Star Ratings

As health plans consider how to meet the new Medicare Advantage Star Ratings programs, they will need to design surveys and advanced analytics tools to support their member experience improvement strategies, revealed a report from McKinsey & Company.

CMS adjustments to the Medicare Advantage Star Ratings have placed a far heavier emphasis on customer experience.

While member experience is already a fundamental aspect of Medicare Advantage Star Ratings conferring around $15 billion in incentives, by 2023 it will make up 57 percent of the overall Star Ratings score.s.

In three years, the measures that fall under patient experience and complaint measures will contribute 36 percent of the weight, as opposed to 20 percent in 2020. Measures related to capturing access will increase from 12 percent of the weight to 21 percent.

This move will diminish—but not eliminate—the emphasis on process measures, which will drop eight percentage points in weight, and outcome measures, which will decrease in weight by seven percentage points. It means that even five-star payers with member experience scores of less than five may decline in their overall rating and, as a result, in their revenue.

“Maintaining performance may not be enough to maintain the plan’s current customer experience measure scores,” the report stated. “As other plans improve their performance on customer experience metrics, the threshold performance required to earn high Stars ratings on customer experience measures could increase since Stars measures are scored on a curve.”

Plans that do not have an overall five-star rating, on the other hand, are incentivized to put their energies into achieving high scores on member experience. In certain situations, achieving a high member experience score has the power to raise a health plan’s rating by one full Star.

Of course, Medicare Star Ratings are not the sole incentive for putting more effort into member experience. A positive member experience can lead to higher enrollment, higher plan employee satisfaction, and lower costs.

This will be no easy task for most payers. For years, the payer industry has seen low consumer satisfaction, particularly with member engagement, which is key to member experience.

The researchers recognized that increasing incentives for strong member experience does not inherently mean plans know how to strengthen member experience.

Payers often rely on surveys to tell them how members are feeling about their payer’s customer service and what they are looking for in a health plan.

But these surveys can produce dubious results. Surveys do not necessarily represent a large—or even significant—portion of the member population, do not provide real-time data, focus on the outcomes instead of the causes of negative customer experiences, and they often are not comprehensive enough, failing to integrate member-level financial and operational data.

However, the researchers acknowledged that this form of processing member feedback is indispensable for the quality measurement process.

To improve the survey and member feedback collection process, plans should develop detailed member care journey maps. The researchers noted that this could include over 100 touchpoints annually.

The member care journey map will help plans target their surveys more effectively in the timeline of release and survey content.

For example, a survey conducted by McKinsey found that members placed higher importance on having a positive experience filling prescriptions, renewing their health plan, managing expenses, and submitting a claim.

Plans can also more effectively identify areas for improvement in the member experience when they implement advanced analytics.

“More nuanced insights can rely on customer, financial, and operational data in real time to fuel machine-learning algorithms that identify the most valuable customer segments, as well as the experiences making the greatest impact on those customers’ sentiment and value outcomes,” the report stated.

A previous McKinsey & Company report identified a three-step strategy to improve member engagement leveraging advanced analytics, personalization, and behavioral economics.

First, they recommended that payers use advanced analytics to identify their target member populations and individuals. Advanced analytics—particularly episode analytics—can enable payers to predict healthcare spending and member behaviors which the payer can then input into empathy maps that isolate member priorities.

Second, payers can use that data to shape their messaging. The messaging must contain the solution which the member is looking for, it must incorporate other priorities indicated by the advanced analytics data, and it must be delivered through the member’s preferred platform.

Finally, payers should optimize engagement by targeting not just members, but also their care providers. Developing a member engagement team can be key to making this work.

This year, 21 Medicare Advantage Part D plans received five-star ratings in Medicare Advantage Star Ratings.