Health plans aren’t well-positioned to control the conditions of most covered services received by members, such as urgent care wait times, a doctor’s bedside manner, or insufficient hospital staff.
Instead, plans should focus on the benefits they can control to optimize member satisfaction. For Medicare Advantage plans, federal reimbursements are determined based on quality and performance measures, and member assessment influences Medicare Star Ratings. It’s more important than ever for plans to take the wheel and deliver excellent member experience.
Historically, a traditional non-emergency medical transportation (NEMT) benefit delivered by a broker is a service that health plans aren't able to oversee or manage. However, intelligent digital platforms can help health plans gain full control and insight real-time visibility into how their members utilize their transportation benefits to access the care they need. As significant shifts in ratings start to settle, Medicare Advantage plans should consider partnering with a digital NEMT platform that gives them full, real-time visibility into members’ rides and allows them to intervene and course-correct a ride if needed, reducing the likelihood of complaints and grievances, and ultimately drive up Star ratings.
A New Year Brings New Challenges
As a result of provisional changes to the Medicare Star rating methodology in response to the COVID-19 pandemic and timely quality improvement initiatives, Medicare Advantage plans had their strongest Star ratings year ever in 2022. During the course of 2022, the average rating across all plans reached 4.37; 68% of plans earned four Stars or above; and 74 contracts earned the highest honor of five Stars.
Unfortunately, 2023 is not looking as stellar. Thus far, Star ratings are trending downward.
The average rating dropped to 4.15; 51% of plans earned four Stars or above; and the number of five-Star contracts fell by 23%. One analysis predicts plans could experience $800 million in revenue impacts from ratings changes, and half of plans could have less Stars.
While these fluctuations may appear dramatic, the variations signify a return to more standard, pre-pandemic scores. Last fall, the Centers for Medicare & Medicaid Services (CMS) announced the following changes to the method of calculating Star ratings.
- The universal disaster provision ended, which allowed contracts to take the “better of” current or historical performance for most measures in 2022
- There are guardrails on changes in cut points for non-CAHPS measures beginning in 2023
- For rating year 2024, CMS will remove performance outliers from the calculation of cut points using the Tukey outlier deletion method
- The weight of member experience on a plan’s rating increased to about 57%, quadrupling previous years' influence
In addition to CMS’ changes, member expectations are at an all-time high with 86% of members enrolled in a plan with four or more Stars in 2022. Also, given the unpredictable economic environment, members want to ensure they’re getting the most bang for their buck.
To balance the effects of the new methodology and still achieve and maintain a high Star rating, Medicare Advantage plans need to determine how to adjust and refocus their efforts.
Opportunity lies in improving the overall member experience. Plans should review the full member journey, identify all touchpoints, and understand the root of both member grievances and gratification. One consulting firm recommends plans proactively track members’ opinions at key interaction points and create a culture of continuous, sustainable innovation that improves interactions quickly.
Without current insight into most covered benefits, plans should steer their attention to the services that allow them to control the outcome, like NEMT. With a digitized NEMT platform, health plans are in the driver’s seat and can directly influence member experience. Plan administrators often cite transportation as a main driver of grievances, underscoring the need to choose a NEMT partner whose commitment to service excellence drives their people, their platform, and their purpose.
Modern Technology Unlocks New Opportunities
Traditional NEMT partners offer little to no visibility to their health plan partners. Typically, brokers' communication and reporting lacks meaningful and actionable insights, creating an unavoidable “black box” situation that leaves stakeholders – and members – in the dark.
SafeRide has transformed the NEMT brokerage model for the digital age by placing the member at the center, aligning with health plans' objectives to boost members satisfaction scores. By partnering with technology-first transportation platforms like SafeRide, health plans can seamlessly control the quality and integrity of their NEMT benefit. Unlike legacy brokers, SafeRide empowers health plans to monitor ride data and member experience in real time, enabling them to make smarter decisions, improve member retention, and drive plan expansion.
Once the SafeRide transportation platform alerts the health plan that an issue has occurred, immediate intervention can take place to help the member. For example, when alerted about a late ride (or even before the ride is actually late), the SafeRide platform can find and assign a new driver right away. There is less risk of a dissatisfied member filing a grievance when an issue is resolved quickly before the member themselves are even aware. As a bonus, the on-demand ride request and seamless experience aspects of a digitized NEMT benefit may convince Medicare beneficiaries to choose one plan over another.
Candidly, the next few years may be difficult for Medicare Advantage plans as they navigate a more demanding Star rating methodology. However, staying the course is important, as a high Star rating has a profound impact on a plan’s economics. With Star ratings heavily influenced by member experience, plans need to put in the effort to satisfy the new algorithm. There are several steps health plans can take now to both secure future high Star ratings and advance access to care. SafeRide helps health plans focus relentlessly on the member experience while elevating the NEMT benefit from every angle.