Guest Blog: 5 Tips from a 5 Star Plan

By Dr. Jonathan Harding, MD

As the Senior Medical Director for Tufts Health Plan’s Five Star Medicare Advantage and FIDESNP products, I’m often asked about our secret to achieving the coveted Five Star Rating. In reality, we don’t have just one secret – we have five focused strategies that we keep front of mind (read on and you’ll see what I’m referring to).

To achieve the kind of results we have, it takes a lot of hard work, a dedicated team, a passion for improving member care and consumer-centric technologies.

Star Ratings Matter

If you manage a Medicare Advantage plan, you know the importance of the Five Star Ratings system. The Ratings range from one (lowest) to five (highest) Stars. Created by the Centers for Medicare and Medicaid Services (CMS), the Star Ratings system allows for increased accountability for health plans, health systems and providers. It measures five broad categories, including:

  • Preventive care (health tests and screenings, vaccines)
  • Chronic disease management
  • Quality of care and responsiveness to members
  • Member complaint handling, and how many members leave the plan
  • Overall customer service

Aside from the Five-Star seal to showcase a higher quality of service, one of the most unique benefits of being a Five Star plan is that you qualify for a longer special enrollment period. This allows for plans to be more competitive with member acquisition efforts in the marketplace. In short, a Medicare Advantage plan’s Star Ratings matter, and they matter a lot.

My Top 5 Tips  

Whether a plan wants to gain a few points or maintain their current spot, here are my top five tips for becoming a Five Star plan:

>>> TIP #1: Make the member the focal point of your strategy.

Medicare seeks out members’ input about their ease of getting appointments and care, getting necessary information from the plan, coordination of benefits and their overall experience with the health plan. Some processes or technologies may be designed from the plan's perspective to handle operational or administrative needs, but are not member-centric or user-friendly. Are they being bombarded by coordination of benefit letters?  How many steps does it take to schedule an appointment?  Are they aware of free preventive benefits? Put yourself in the members’ shoes. Member satisfaction and experience with the health plan is a significant portion of the Star Ratings system, so keeping them engaged in their health has its direct benefits – not only for the member but for the health plan as well.

>>> TIP #2: Incorporate a multi-channel communications approach into your outreach efforts.

Communication is a critical aspect of the health plan and member relationship, and it’s one that Medicare takes very seriously. Sending mass communications to members and assuming that they will respond is fairly ineffective. Today’s technology enables plans to communicate with members based on their preferences and across multiple channels. Plans that take a multi-touch approach, such as a combination of text, email, IVR, and/or paper mail will definitely see an uptick. For example, Tufts Health Plan mailed a paper HRA (a CMS requirement), but the response rate was low – less than 50%. To help improve the response rate, we partnered with Welltok’s engagement team to coordinate a multi-channel outreach campaign, which included phone calls, access to a website with information, and for those who prefer it, mail. We saw an immediate increase in response rates:

  • 69% HRA survey completion rate
  • 49% completed HRA via outbound automated call
  • 83% who started the outbound call survey, responded to all 34 health-related questions
  • 53% increase in overall survey completion with web & paper completes
  • 21% lift in completion by allowing members who started survey via automated call to finish via web or paper

>>> TIP #3: Measure and report continuously.

Don’t wait for Medicare to survey your members to get an understanding of their perception of the health plan. Instead, be proactive and collect data throughout the year. For example, ask for member feedback before Medicare’s CAHPS surveys are distributed. As stated above in tip #2, use a multi-channel approach to gain the most engagement. Oversampling your population and having drill down questions that provide real-time consumer data is very valuable. At Tufts Health Plan, we utilize IVR for our surveys – it’s the most cost effective and allows us to collect information from a majority of our target population. Our surveys, for the most part, are predictive of the CAHPS survey to help us anticipate where we need to make improvements.

>>> TIP #4: Have a solid relationship with your provider network.  

Apart from having a good relationship with members, another relationship to keep in focus is the one health plans have with their provider network. Having a strong, symbiotic and productive relationship means that health plans and their provider network understand that they share risk when it comes to the health and wellbeing of the members/patients. This relationship needs to be built over time. At Tufts Health Plan, we work very hard to maintain a solid foundation with our provider network. For us, they are key partners for delivering high quality care for our members, especially related to Stars measures around preventive care and chronic disease management.

>>> TIP #5: Have a dedicated strategy, time and focus on Star Ratings specifically.

High Star Ratings don’t happen overnight. It takes time, resources and a lot of dedication to achieve. All Star measures are important and they need to be worked on year-round. There are more than 40, so divide and conquer. From steering to reporting committees, we’ve developed an organized structure to hold our staff accountable. We have an entire team focused just on Stars and each year, our focus may shift more from one measure to another, however we do work on every single one. In the world of Star Ratings, you have to keep improving and be better than the year before.

Bring it all together

It takes a lot of work to become and maintain the Five Star Rating status. We face challenges every day – from budget restraints to staff turnover to limited provider bandwidth – however, we haven’t lost sight of the people we serve and the care we provide. Our mission is to improve the health and wellness of the diverse communities we serve, which is rooted in our Stars improvement strategy. Each year, our goal is to be better, more effective and efficient than the year before. It’s an ongoing process and we do it with our members in focus.

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About Dr. Jonathan Harding, MD

Dr. Jonathan Harding is currently the Senior Medical Director of Senior products comprising a population of over 120,000 Medicare and Retiree members at Tufts Health Plan in Massachusetts. Prior to this position, he was at Touchstone Health Partnership, where he served as Vice President for Health Services. Prior to that he was Chief Medical Officer of the Fallon Clinic in Worcester, MA, a multi‐specialty group practice with over 300 practitioners, and held several different positions at FHP in California, a multi‐faceted health care company with HMO, medical group, and hospital businesses. He also continues his role as a physician reviewer for the National Committee on Quality Assurance (NCQA). He brings over 25 years of experience in medical management. Dr. Harding received his bachelor’s degree and his degree in medicine from Boston University and he is board certified in internal medicine and geriatric medicine. He also has been certified by the ABMM and ABQAURP, and is a Fellow of the American College of Physician Executives. Dr. Harding has previously taught Internal Medicine at the University of California, Irvine, School of Medicine; the University of Massachusetts Medical School in Worcester and in Uganda and South Africa.

About Tufts Health Plan

Tufts Health Plan is nationally recognized for its commitment to providing innovative, high-quality health care coverage.  Staying true to our mission of improving the health and wellness of the diverse communities we serve, we touch the lives of more than 1.1 million members in Massachusetts, Rhode Island and New Hampshire through employer-sponsored plans; Medicare; Medicaid and Marketplace plans, offering health insurance coverage across the life span regardless of age or circumstance.

We are continually among the top health plans in the country based on quality and member satisfaction:

  • Our private HMO and Massachusetts PPO plans are rated 5 out of 5 and our Massachusetts Medicaid plan is rated 4.5 out of 5 by the National Committee for Quality Assurance.[i]
  • Our Tufts Medicare Preferred HMO and Senior Care Options plans received a Five-Star rating from the Centers for Medicare & Medicaid Services, the highest rating possible.[ii]

To learn more about how we’re redefining what a health plan can do, visit tuftshealthplan.com/connections. Connect with us on Facebook, Twitter, YouTube and LinkedIn.

(i) The National Committee for Quality Assurance Private Health Insurance Plan Ratings and Medicaid Health Insurance Ratings 2017-2018. This rating references Tufts Health Plan’s Massachusetts Medicaid plan.  Tufts Health Plan’s Rhode Island Medicaid plan has not yet been rated. (ii) Medicare evaluates plans based on a Five Star Rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov. Tufts Medicare Preferred HMO plans received 5 out of 5 stars for contract years 2016-2018.