Star Ratings are incredibly important for Medicare Advantage plans for many reasons, including eligibility for bonus and rebate payments. If your Medicare Advantage Plan Star Rating is 3.5 or 4.0, increasing it can mean a significant boost in your overall revenue and profitability, with an additional win that improved customer satisfaction can help improve retention.
Why Are Medicare Advantage Star Ratings So Important?
Medicare Advantage plans rated 4.0 and higher are eligible for quality bonus payment (QBP) reimbursement. The highest quality rated plans with Star Ratings of 5.0 receive the largest bonuses. Medicare Advantage plans that receive value-based reimbursements are required to invest that money toward more consumer benefits, and thereby have a better product to compete for members during the next open enrollment period. Quality bonus payments are truly a win-win situation.
Increasing Member Retention is Also Key to Boosting Your Revenue and Profit
While Star Ratings are critical to profitability, so is member retention. Retained members generate more profit than new members because marketing, onboarding, and other costs related to attracting new members hurts year one profitability.
For example, an existing plan with 50,000 members might lose 8% of its members to a competitor, or 4,000 members who opt out of their current plan. If average revenue per member is $12,000, that’s $48,000,000 lost. If you could cut the loss from 8% to 6%, which is a very attainable target, you’d generate incremental revenue of $12,000,000!
Medicare Advantage Quality Scores are Becoming More Customer Experience Focused
In 2020, the Centers for Medicare & Medicaid Services (CMS) changed the way quality scores are calculated, placing increasing emphasis on customer experience.
The result is that by 2023, customer experience measures, which are captured by the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys, will drive 57 percent of the total Star Rating. This is up 25 percentage points from 2020, and therefore reflects a significant change in methodology, presenting both opportunity and risk.
The opportunity is that plan operators who are able to improve their customers’ experience can potentially benefit from both increased retention and higher quality bonus payments. The risk is that plans who don’t succeed in improving their customer experience metrics may receive much lower, or even no quality bonus payments, and may even lose members.
Plans with Star Ratings of 4.0 are especially vulnerable because if they fall to 3.5 they’ll receive no quality bonus. This can significantly impact their revenue and profit, as well as their ability to compete for new members during the next enrollment period with a more compelling plan thanks to the quality bonus payments.
It’s clear that the stakes are incredibly high as customer experience metrics become a more powerful lever in increasing overall Star Ratings.
The great news is that there is a wide range of strategies that can be leveraged to improve your plan’s customer experience.
Customer Experience is Not the Same as Customer Satisfaction
Given the importance of CAHPS surveys to your plan’s Star Rating, it’s critical to understand the survey’s objective. CMS states: “Patient experience surveys focus on how patients experienced or perceived key aspects of their care, not how satisfied they were with their care.”
The key takeaway is that customer experience is not the same as customer satisfaction.
Why this distinction matters so much is that a plan subscriber may not be fully satisfied with the outcome of their medical encounter (e.g., what they sought treatment for was not completely resolved), but they may still be satisfied with their experience with your plan because they believe that they received outstanding service and support during the course of their treatment.
While you cannot control health outcomes, you do have a large degree of influence on consumers’ experience with your product and the accompanying service, and therefore you have an opportunity to increase your CAHPS results by working to improve customer experience.
Areas of Focus for Improving Customer Experience
A great starting place to improving customer experience, as measured by the CAHPS survey, is to understand the areas covered by the survey questions. CAHPS “Questions ask about ease of getting needed care and seeing specialists, getting appointments and care quickly, doctors who communicate well, coordination of members’ health care services, health and/or drug plan provides information or help when members need it, ease of getting prescriptions filled, rating of health and/or drug plan, rating of health care quality, annual flu vaccine, and pneumonia vaccine.”
The question areas over which you have the most influence to impact include:
- Ease of getting needed care and seeing specialists
- Coordination of members’ health care services
- Information or help when members need it
- Rating of health plan
- Support for annual vaccines and screenings (e.g., colonoscopy, mammograms, etc.)
Additionally, there’s an opportunity to provide personalized support and communications for your members who have chronic conditions.
There are many strategies that can be pursued to improve plan performance in the above areas, and it’s likely that your internal quality reviews have already identified key leverage points, and that you have long-term implementation plans underway.
The challenge is that many larger plan improvements require substantial investments and lengthy timeframes, and therefore it can take many months, or even years, to positively affect your Star Rating.
A Strategy that can Quickly Improve Customer Experience
Customer Experience is heavily influenced by whether or not your members believe you genuinely have their best interests in mind in all you do. Every touch point has the power to either add or subtract from their overall opinion of their customer experience.
Members come into your Medicare Advantage plan with a set of core expectations they want you to meet, and the majority of plans rated 3.5 and higher will largely succeed in this respect.
With core expectations met, there’s a massive opportunity to go one step further to surprise and delight them.
This can be achieved when you give your members something entirely unexpected, either as a reward for taking an action that also benefits them, or ‘just because’.
One of the best ways to do this is to offer rewards to encourage proactive health behaviors and incentives to change behaviors.
Members love receiving incentives as proven by the loyalty and reward programs that are available from virtually every major consumer brand.
Given the popularity of rewards and incentives, the next step is to determine how are they best used to help you generate the results you desire.
How to Use Rewards and Incentives to Improve Medicare Advantage Plan Customers’ Experience
Programs that offer incentives to drive member participation and engagement empower members to take greater ownership of their health. Many Medicare Advantage Plans have started offering their members a variety of rewards for taking specific actions (e.g., get your annual flu vaccine and you’ll receive a _____!).
This approach, which is permitted by CMS, offers multiple benefits to your plan including:
- Greater awareness among members about the importance of taking personal steps to better health
- Adding value to being your member
- Helping strengthen and differentiate your brand as being highly focused on member health
- Improving the member service delivery experience
Members also benefit from incentives, especially if they are relevant and meaningful to their lifestyle.
In addition to receiving the reward itself, your members benefit by taking steps to protect their health by getting the proper screenings and tests that could identify serious conditions early, and therefore potentially result in better outcomes.
While rewards and incentives programs can improve customer experience, building an effective rewards program as an incentive to drive participation in Star Rating measures presents several challenges.
First, a program with multiple rewards can be a complicated, costly undertaking, which is difficult to implement and hard to execute. Doing it internally can distract your team’s attention from the core focus of running a great Medicare Advantage plan for your members.
Next, developing and delivering high-value, low per-member cost incentives that are compelling enough to influence member participation and behavior is a significant challenge.
Most importantly, organizations must also ensure their rewards programs are compliant with the established guidelines from CMS. Failure to comply can result in substantial penalties and potential sanctions.
Ultimately, in order to ensure success, you must choose the right incentive mix and delivery platform, as well as the right partner who’s an expert in Medicare Advantage and has the resources to execute both the big and small details of your program.
Entertainment® is Your Ideal Medicare Advantage Plan Customer Experience Incentives and Rewards Partner
Entertainment Rewards & Incentives has been driving member engagement, across many industries, for over 30 years.
For over a decade, our team has worked extensively with dozens of healthcare clients to generate strong results with our Healthy Living Rewards programs.
From our extensive experience with helping Medicare Advantage Plan clients improve their customer experience, we’ve learned that successful rewards programs:
- Drive wellness initiatives among members
- Inspire healthier, more active lifestyles
- Generate long-term cost savings for plan participants and insurers
- Improve satisfaction and member retention
- Strengthen cooperation and compliance with CMS measures
- Impact Star Ratings, bonuses, and rebates
We know how to build and deliver comprehensive, integrated healthcare incentive programs that deliver results.
Based on a Member Satisfaction Survey by a major plan who partnered with Entertainment, the integrated rewards plan helped deliver higher ratings. Respondents Strongly Agreed / Agreed with:
- 78% — “Due to this program I am motivated to take better care of my health”
- 82% — “My health plan cares about keeping me healthy”
- 80% — “My health plan is trying to help me make better healthcare decisions”
What makes Entertainment unique in rewards and incentives for Medicare Advantage Plans is that we are able to deliver a highly effective program at a fraction of the cost of gift card programs.
Also, our proven, low-cost programs can be implemented in as quickly as 30 days. This enables you to experience a substantial positive impact on your members’ customer experience, without a lengthy wait for program development.
Our Entertainment Healthy Living Rewards Programs Offer Your Members Tremendous Value
The key to our incredible success in helping Medicare Advantage plans deliver an even strong customer experience is that the foundation of our all our rewards and incentive programs is a large and unmatched collection of highly attractive savings.
Our offers are especially valued by senior citizens, many of whom are on fixed incomes, because they are dining out, traveling, and shopping at record rates. Therefore, they appreciate and value discounts, on things they do every day, that they can’t get elsewhere.
And senior discount programs are no longer as strong as they once were, with many providing savings of only 5-10%, making our offers even more distinctive and attractive.
Entertainment’s programs are powered by:
- North America’s largest and most valuable savings network – over 500,000 ways to save
- High usage discount categories – dining, attractions, travel, shopping, and more
- Exclusive best in class discounts – BOGO and up to 50% savings
- National, regional, and hyperlocal sales teams – not an affiliate aggregator
- Directly contracted with merchants
- Ability to custom curate offers from our thousands of merchant relationships
- Dining category focus – represents 80% of offer usage
- Average merchant Yelp® rating – 4.2/5
- Hyperlocal footprint – fuels 60% of redemptions
- 100% MSA coverage, 98% Micropolitan market coverage
Our comprehensive reward and incentive programs provide you with a proven, low-cost way to further enhance your members’ customer experience, and we can deliver an entire, customized program in as few as 30 days.
Also, we have an expert technology team who can work with your team to deliver a fully customized solution that integrates seamlessly with your digital properties.
Reach out to us today so we can leverage our extensive healthcare and Star Ratings expertise to help you reach your revenue and profitability goals, while delighting your members with best-in-class savings on things they do every day!