Medicare’s Ratings Update Shows Growing Focus On Patient Experience

Medicare is making changes to how it values the experiences of its members.


Medicare's Ratings Update Shows Growing Focus On Patient Experience

Reviews and user feedback are two essential drivers of how people select products. In fact, 90% of online consumers feel their buying choices are influenced by product reviews. Most of the time, we think about this statistic as it relates to physical products. We look at reviews on Amazon or other big online stores before making a purchase, but reviews matter everywhere.

Taking this into account, Medicare is making changes to how it values the experiences of its members. Placing more weight on member experience and complaints, the Centers for Medicare & Medicaid Services (CMS) is updating its Five-Star Quality Rating System to better reflect the patient experience.

Although these changes won’t take effect until 2023, according to an article by HealthLeaders, “consumers will be asked to consider their perceptions about their plans beginning in the latter half of 2021.” The article notes that since Star Ratings both help consumers decide which plan they want and impact plans’ eligibility for quality bonus payments, the scores matter a lot.

Perhaps the biggest area where Medicare plans can start improving is in information and communication. A study conducted by J.D. Power found that this particular area is weak when it comes to member satisfaction. This is an issue as communication is an essential area when it comes to a member’s experience since Medicare is often complicated to fully grasp.

Star Ratings are based on a five-star system. For Advantage plans, measures are divided into five categories, and each category is weighted between one and five. Ratings are given within each individual category along with one overall Star Rating that summarizes the plan’s performance as a whole. The overall rating makes it easy to compare plans, in general terms. However, for those looking for plans with specific qualities, it’s possible to get deeper into the details.

With this increase in value, patient experience and complaints measures will contribute 32% of the overall Star Ratings score by 2023, according to a July Radar on Medicare Advantage article. This could, however, mean there’s a lot of work ahead for some Medicare plans. In the article, Deloitte Consulting’s Akhil Rao noted that plans that have already begun to evaluate their business with a customer experience focus will have less to change as adjustments to existing strategies will be smaller and easier to implement. But he said many local or regional plans that struggle now in this particular Star Ratings category, though, are in for some hard work.

One way I believe companies can improve the customer experience is to better communicate the basics of each policy. From my experience, enrollees are often drawn to the $0 monthly premiums offered by plans as well to things that Original Medicare does not cover, such as dental, vision, hearing and in some cases gym memberships. Communicating that some of these additional benefits can come with limitations would help an enrollee be better prepared when they need to use these services. 

Another common area I see that could be improved upon is to better inform enrollees about plans’ networks and service areas, and what services may require pre-authorizations under the plans. Having a better understanding of a plan’s network and how the referral process will work would help the enrollee better navigate their health insurance. This would, in turn, improve the customer experience and avoid any misunderstandings. 

The good thing overall is how much value CMS is putting on the customer. These changes demonstrate a desire to make Medicare more user-friendly for members, which in turn will make it easier to find a plan that both works for an individual’s needs and makes them feel good about purchasing it. In a world where user feedback is only becoming more important, this step lets Medicare members use their voice to impact the future of their health coverage and keep others in the loop about what options really are the best.



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About Greg Gurbikian

Gregory Gurbikian is the co-founder and President/CEO of Healthcare Solutions Direct, LLC . With over 12 years of experience in the industry, Greg is dedicated to simplifying the process for both its customers and employees.

Under his leadership and vision, Healthcare Solutions Direct, LLC has become one of the nations top agencies servicing the more than 44 million beneficiaries on Medicare. With close to 11,000 people a day turning 65, those on Medicare are projected to rise to over 79 million by 2030. Healthcare Solutions Direct, LLC is poised with cutting edge technology and training to help service the transition of those going onto Medicare from start to finish. .

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