How CMS Star Ratings impact your health plan

October 31, 2024

Press Ganey

In today’s competitive healthcare landscape, understanding and improving member experiences is essential for the success of health plans. One of the most effective ways to gauge and enhance member satisfaction is through CMS Star Ratings. At Press Ganey, we specialize in turning detailed member experience data into actionable insights that enable health plans to achieve exceptional CMS Star Ratings and, consequently, higher levels of success.

CMS Star Ratings: Why should 5 stars matter to you?

The Centers for Medicare & Medicaid Services (CMS) uses a 5-star rating system to evaluate the performance of health plans. These ratings are crucial for identifying high-performing health plans and providing valuable insights into member satisfaction.

Here’s how a 4+ CMS Star Rating can impact your organization.

1. Improved member experiences

A high CMS Star Rating reflects a superior member experience. When health plans prioritize and improve certain aspects (like customer service and care accessibility), member feedback tends to be more positive. This not only enhances overall member satisfaction but also builds trust and member loyalty.

2. Higher member enrollment and retention

A higher CMS Star Rating translates to increased member enrollment and improved retention rates. Potential members are more likely to choose a health plan with a 5-star rating. And existing members are more likely to stay with a plan that consistently meets or exceeds their expectations for quality healthcare.

3. Increased revenue

Medicare Advantage plans with a 4-star (or higher) rating are eligible for quality bonus payments from CMS. This means a top CMS Star Rating can significantly boost revenue, giving health plans the capital to further invest in member care and services.

4. Competitive advantage

In a crowded market, a Star Rating of 4+ can set your health plan apart. CMS Star Ratings serve as a key differentiator and competitive advantage that attracts new members and reinforces loyalty among existing ones.

5. More effective marketing

A high Star Rating is a powerful marketing tool. Highlighting your 5-star rating in marketing and promotional materials can boost your brand’s reputation in front of a broader audience and attract more members.

How Press Ganey helps improve CMS Star Ratings

Partnering with Press Ganey can be a game-changer for health plans looking to boost their CMS Star Ratings. Our expertise in healthcare analytics and member experience management helps health plans improve their Star Ratings. Here’s how.

Expert data analysis

We use sophisticated data collection methods and comprehensive analysis to uncover key insights into member experiences. Our approach gives you actionable recommendations tailored to your health plan’s specific needs.

Focused performance improvement

We concentrate on critical areas like member satisfaction, timely access to quality care, and effective communication. Press Ganey’s strategies are designed to address these key performance metrics, driving improvements that positively impact CMS Star Ratings.

Strategic recommendations

Press Ganey’s team of health plan and member experience experts provides clear, strategic recommendations based on thorough analysis. These insights help you implement targeted improvements that can lead to higher Star Ratings and better overall performance across key health plan metrics.

Success story: How partnering with Press Ganey paid off

A global health plan improved its CMS Star Ratings 20% within just one year of working with Press Ganey, adding $21 million in annualized growth from member retention alone.

The Press Ganey difference

We’re dedicated to innovation and excellence in health plan analytics. Our advanced tools and experienced team ensure that health plans receive the most accurate and actionable insights.