How to Maintain a High Star Rating for Medicare Advantage—and Why It Matters

The annual enrollment period is crucial in determining the success of a Medicare Advantage health plan. Still, it’s not the only thing affecting your organization’s success. Your star ratings can set you apart from your competitors. If your ratings are low, you risk losing current members and deterring new enrollees. But with high star ratings, you often increase member retention and enrollment.

The Centers for Medicare and Medicaid Services (CMS) determine star ratings based on up to 38 quality and patient experience measures. The ratings range from one to five stars in half increments. Star ratings guide consumers in choosing high-quality providers of a plan, encouraging them to stick with their selected provider with little to no interest in canceling enrollment. Read on to learn strategies to help you maintain a high star rating for your health plan.

Recruit the right talent for your team.

Good staff is essential to success, especially during the open enrollment period. Of course, implementing ongoing training will strengthen your current team, but hiring new talent who is experienced with Medicare Advantage and familiar with star ratings can optimize your enrollment outcome. Consider applying new healthcare staffing strategies to ensure you employ proficient healthcare advocates. 

Develop a staff of talented professionals whose objectives align with yours. As they apply the right skills and attitude to member engagement, your company will maintain overall positive consumer satisfaction. The happier your members are, the higher your star ratings will be, and the better your retention rate will remain.

Address negative member experiences promptly.

Rather than waiting for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results to gauge your consumer experience, implement a survey system. Companies typically receive CAHPS results that carry generic responses toward the year’s end. These delayed results could leave you with limited information for making significant improvements. 

Instead, regularly administer consumer pulse surveys to understand your consumers’ specific challenges. You can also discover sources of dissatisfaction and work with your staff to resolve them promptly. Addressing these issues sooner rather than later can help your enrollees feel seen and heard, improving their satisfaction, increasing their enrollment loyalty, and boosting your star rating related to your Medicare Advantage offering.

Show interest, even in adverse situations.

Proactively engage with your members by routinely checking in to ensure they receive annual wellness checks and flu shots. Your healthcare team can work to encourage members to follow through with recommended care, which can decrease providers’ expenses by having healthy patients. However, your staff may be inclined to avoid difficult conversations, such as a member’s plan cost increase.

View these adverse situations as an opportunity to engage with your consumers and express interest in not only their physical and mental health, but also in their financial well-being. When there’s an upcoming annual plan increase, contact your members directly and alert them of the expected change. The conversation can turn positive if you offer additional support by suggesting alternative health plans your company provides or even noting generic equivalents to their prescription medication. Showing your members that you care is an effective way to improve your star ratings and help them maintain their health coverage.

Why does a high star rating matter?

Aside from providing your enrollees with the best quality of service and meeting their most complex healthcare needs, maintaining a high star rating offers several benefits to your organization. Consider the following incentives for increasing your star rating to its highest potential:

  • Health plans with high star ratings can receive bonuses: To ensure high-quality standards, the CMS instated a quality bonus system. Medicare Advantage health plans with the highest performance rating of five stars are eligible for the largest bonus payment, equal to 5%. Health plans with a four-star rating and above also qualify for a bonus. The bonus further incentivizes providers to improve service quality by offering increased capitated payments and rebates. Note that rebate bonus payments must go toward expanding enrollee benefits.
  • Higher star ratings equal better benefits for providers: Studies show Medicare Advantage health plans with excellent ratings experienced a notable 3.4% increase in the use of higher-rated hospitals. There was also a decrease in enrollment loss, as more enrollees kept their enrollment with higher-rated health plans. This decrease is especially consistent with enrollees who have complex healthcare needs. 

Investing time into cultivating a proactive staff, managing member complaints, and staying engaged is worthwhile for improving and maintaining a high star rating. Use these strategies to increase your star ratings and chances of appealing to a broader enrollee base for future open enrollment periods. It will create a win-win for your organization and the people you serve.

Read about other ways to prepare for a rise in Medicare Advantage in our guide here. 

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