5 Tips from a 5-Star Medicare Advantage Plan
By John Harding, MD – Welltok – January 28, 2019
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:
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:
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.
Medicare Blog | Medicare News | Medicare Information
CMS proposes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage
Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes that will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.
“CMS is committed to modernizing Medicare and our top priority is to ensure that seniors have more choices and affordable options in receiving their Medicare benefits,” said CMS Administrator Seema Verma. “Medicare Advantage enrollment is at an all-time high as more and more seniors are choosing to enroll in private Medicare health and drug plans, and we need to maximize competition by providing plans the flexibility to meet patients’ needs.”
The proposed changes will expand opportunities for seniors to choose Medicare Advantage plans that for the first time are providing new supplemental benefits in 2019. Beginning with the 2019 plan year, Medicare Advantage plans can provide certain enrollees with access to different benefits and services. For the 2020 plan year and beyond, under statutory changes and the proposed guidance on which we are soliciting comment in today’s release, Medicare Advantage plans will have greater flexibility to offer chronically ill patients a broader range of supplemental benefits that are tailored to their specific needs, such as providing home-delivered meals or transportation for non-medical needs.
The agency is also proposing new action to combat the nation’s opioid crisis. CMS is encouraging Medicare Advantage plans to take advantage of new flexibilities to offer targeted benefits and cost sharing reductions for patients with chronic pain or undergoing addiction treatment, and encouraging Part D plans to provide lower cost sharing for opioid-reversal agents. CMS’ overutilization policies have resulted in a 14 percent decrease in the share of Part D beneficiaries using opioids between 2010 and 2017 (36.3 percent to 31.3 percent), with the largest decrease from 2016 to 2017 (5 percent).
Medicare Advantage remains a popular choice among beneficiaries and has high satisfaction ratings. Average Medicare Advantage and Part D premiums are at their lowest in three years and plan choices have increased. Today’s proposals build in additional flexibilities to continue to increase choice and competition among Medicare health and drug plans.
For a fact sheet on the 2020 Advance Notices (Part I and Part II) and the Draft Call Letter, please visit: https://www.cms.gov/newsroom/fact-sheets/2020-medicare-advantage-and-part-d-advance-notice-part-ii-and-draft-call-letter. CMS released Part I of the Advance Notice on December 20, 2018.
The 2020 Advance Notices (Part I and Part II) and Draft Call Letter may be viewed by going to: https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/Advance2020Part2.pdf and selecting “2020 Advance Notices.”
All comments on the Advance Notices – including Part I – and Draft Call Letter must be submitted by March 1, 2019. The final 2020 Rate Announcement will be published by Monday, April 1, 2019.
By the Kaiser Family Foundation – January 30, 2019
Part D made prescription drugs more affordable for Medicare beneficiaries, yet many beneficiaries continue to face high out-of-pocket costs for their medications. Part D enrollees not receiving low-income subsidies can expect to pay thousands of dollars OoP for a specialty tier drug in 2019: median annual OoP costs in 2019 for 28 of the 30 studied specialty tier drugs range from $2,622 for Zepatier (hepatitis C) to $16,551 for Idhifa (leukemia). Not all specialty tier drugs are covered by all Part D plans, unless they are in one of the six protected classes (such as cancer drugs).
In 2019, annual out-of-pocket costs are 12% higher than in 2016, on average.
The CMS released a new app yesterday that describes what Medicare will cover, part of CMS’s plan to help beneficiaries decide between coverage options. The What's Covered app will let users see whether Medicare covers a specific item or service.
By Judy Packer-Tursman – AIS Health – January 28, 2019
Opportunities for managed care plans abound in Medicare Advantage (MA), the popular, competitive program that seems to enjoy bipartisan support, experts tell AIS Health.
The bottom line is, “The [MA] payment rate seems OK, and there will be a lot of innovation, heavy advertising, more vertical integration,” says Stephen Wood, managing partner at Clear View Solutions, LLC. “It’s still a very robust market…and the Medicare population is growing by leaps and bounds.”
Wood, along with his partner, Kirk Twiss, describes the MA environment as “market consolidation at the top — with some states virtually dominated by two or three carriers, a few ‘ankle biters,’ and that’s it — and fragmentation, growth and specialization at the bottom.”
The latter includes local provider-sponsored startups trying to launch specialized MA products, he says. But he notes that such startups face fundamental challenges: gaining sufficient enrollment and having enough revenue to cover administrative expenses. Moreover, Twiss points out, it’s “hard to compete against national plans with so many resources.”
On the Medicare Part D side, much remains in play, Twiss notes. Due to industry consolidation and vertical integration, there won’t be independent PBMs, he says, and issues surrounding prescription drug rebates, Part D benefit design and drug pricing are all unresolved.
With MA bids for next year due in early June, Brad Piper, principal and consulting actuary for Milliman, Inc., says “In my mind, flexibility was probably one of the key drivers [of MA] in 2019, and I think we’re going to see that still in 2020.”
The Medicare Advantage program, by including more flexibility on supplemental benefits, is allowing what Piper calls “enticement” benefits. In addition to fitness, dental, hearing and vision benefits, plans increasingly are offering a benefit to help members purchase over-the-counter health-related items, he says, and transportation to the doctor’s office is becoming more popular.
Wood describes them as “sizzle” benefits that are “more marketing oriented than clinically oriented.” He says companies continue to assess how to deliver such benefits and develop solid 2020 bids containing them by the June deadline.
What does the future hold for MA? “At least for the next year, it’s all good news,” Twiss says. “Beyond that, things change very quickly in the health care business.”
According to CMS, the model is intended to test “new incentives for plans, patients, and providers to choose drugs with lower list prices in order to address rising federal reinsurance subsidy costs.”
Last week, the Centers for Medicare & Medicaid Services (CMS)—the agency that oversees the Medicare program—announced that they finished the rollout of new Medicare cards to 61 million people with Medicare ahead of the original deadline of April, 2019. This means that all people with Medicare should now have Medicare cards that include a random Medicare Beneficiary Identifier (MBI) instead of a number based on their Social Security number.
Most documents intended for Medicare and Medicare Advantage members do not meet accessibility standards for the average reader, according to a new report from VisibleThread, a text analysis company.
More than 86 percent of payers offering Medicare products share information with beneficiaries that does not meet federal guidelines for clear, accessible communication as mandated by the Plain Writing Act of 2010.
The law, which started to apply to health insurance providers in 2013, is intended to ensure that entities use plain language, defined as being at or below a 6th grade reading level, to share information with consumers.
According to national statistics from 2003, more than half of Medicare-aged adults (aged 65 or older) are at a “basic” or “below basic” reading level, rendering them unable to understand the typical instructions for taking a prescription medication, for example.
And more than one-third of the United States’ illiterate population is aged 65 or older, equating to 10.6 million elderly adults.
Only 6 out of the 30 payers met recommended standards for plain language communications. Amerigroup, Kaiser Permanente, AARP, Emblem Health, Health Markets, and Aetna all managed to keep their readability scores at or below the optimal threshold.
“Trust in the health insurance industry in the US is declining, according to the Edelman Trust Barometer,” says Fergal McGovern, CEO of VisibleThread.
“This is alarming as trust isn't a 'nice to have'. Lack of trust means less customer loyalty. And that means customers take their business elsewhere. Acquiring new customers becomes more difficult and expensive for organizations.”
The bottom five companies – American National Insurance, State Farm Accolade, the US Government, High Mark, and Liberty Mutual – used twice as many run-on sentences as recommended.
Improving communication with Medicare and Medicare Advantage beneficiaries has become a top priority for payers as more potential members age into the highly lucrative market.
Most beneficiaries are not at all satisfied with the way their health plans share information, provide reminders, or engage them in chronic disease management tasks.
“Leadership needs to define what quality means,” the report stressed. “Teams should be outfitted with the tools to efficiently enforce the standards.”
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Important News on Americo Medicare Supplement: Introducing Great Southern Life Insurance Company
2018 was a very successful year for Americo Medicare Supplement sales and 2019 is going to be even better! Med Supp sales doubled in 2018 thanks to:
To continue building on this success, we are excited to announce:
Beginning March 4, 2019 GSL Medicare Supplement will be available in these states: CO, FL, GA, IL, IN, IA, KS, MD, NC, PA, SC, SD, and TX. There will be additional state releases in June and August. Stay tuned for more information on upcoming releases.
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We look forward to sharing more information on the new Med Supp through Great Southern Life Insurance company as more details become available. stay tuned!