While a focus on Star Ratings for health plans certainly isn’t new, it’s not getting any easier to achieve top marks. The latest 2024 results show the average Star Ratings (weighted by enrollment) fell back to 2021 numbers, and the number of contracts at 4+ Stars dropped from 51% in 2023 to 42% in 2024.
Press Ganey has supported organizations in the pursuit of high-quality performance for years. And from this work, two clear themes have emerged for health plans.
How top health plans design their Stars programs
First, a robust, built-out Stars program is not a project or initiative. It’s a way of operating. It’s a part of an organization’s DNA, and it needs to be grounded in the culture of the people working to achieve excellence every day, with focus and attention to each measure and continuous improvement.
It should come as no surprise that higher overall Star Ratings are associated with contracts that have more experience in the market as part of an MAPD plan. For 2024, 22 of the 31 5-Star health plans have 10 or more years of Medicare Advantage experience. Achieving high Star Ratings is a long game. And, while it may feel like it’s too late to make an impact on 2025, it’s not. For health plan profitability, this isn’t just about 2025: This is about every year moving forward—and the work must start now.
Second, our work with 4.5- and 5-Star health plans emphasizes the continued importance of member and provider experience as the backbone of any Stars program. Highly rated plans create everyday processes that place members and healthcare professionals at the center of their strategy, using continuous listening as well as member and provider feedback to understand where pain points exist across the entire healthcare journey. They’re continually looking to close both the inner loop and outer loop, leveraging data and predictive analytics to ensure they’re targeting the right individuals and overall programs.
- Maximize your investments. With so many measures and areas of focus across Stars, you need to leverage your data to ensure your programs are investing in the right people and the right care journeys. Also understand how they interrelate. For example, underperformance in “Access to Care” measures can also have a major impact on HEDIS performance.
- Partner with providers. Utilize predictive analytics and provider partnerships to ensure your highest-risk members are prioritized between now and the 2024 CAHPS survey cycle. Approximately 70% of all CAHPS survey measures are directly impacted by the member experience in their provider’s office. Leverage internal marketing and engagement programs to drive optimal behaviors too.
- Deliver on the basics. Meeting and exceeding basic member expectations is paramount—as is looking for opportunities to reduce abrasion. Timely claims processing, simplified explanation of benefits (EOBs), on-time transportation, easy-to-use digital apps, and great onboarding experiences are just a few areas of opportunities.
- Limit surprises. The annual election period (AEP) is upon us, and benefit designs are too often confusing. Find opportunities to simplify member benefits, then provide clear education to members and brokers (and key network provider groups). Ensuring members understand their benefits is a consistent top driver of CAHPS performance as well as NPS.
For nearly 40 years, Press Ganey has been the leader in healthcare quality and performance improvement. Ahead of the next survey, we are primed to assist you in focusing on rapid improvement. And, more importantly, we’re ready to help you build and sustain a Human Experience (HX) strategy to ensure measurement and continuous improvement are a part of your health plan culture—so you increase your Star Ratings year after year. Partnering with our team means yours will be capitalizing on a robust experience strategy to serve as the backbone of your Stars program by optimizing the following four areas.
- Continuous listening strategies: Using touchpoint surveys across several parts of the journey ensures improvement efforts are moving the needle in a timely fashion.
- Deep dive member-level surveying: Simulation and drill-down surveys help predict member behaviors and/or understand improvement opportunities.
- Predictive analytics: Your data can reveal predictors of performance to identify members most likely to participate in the survey, as well as key pain points they might be experiencing.
- Focus area prioritization: Leverage data, tipping point and population analysis, and best practice knowledge on domains that can move quickly and those that need to be midterm strategies.
Looking to optimize your approach to Stars? Reach out to an expert on member experience and Stars strategies.