Nearly 4,000 different Medicare Advantage (MA) plans were available to eligible beneficiaries during the 2023 open enrollment period. Almost half of the 28 million-strong Medicare population chooses this private plan option.
Ten years ago, the average beneficiary had 19 MA plans from which to choose. Today, it’s 43.
At stake year to year are quality bonus payments—$10 billion total in 2022—that Medicare awards to MA plans with ratings of four stars or above. Health plans also know that in a world where consumers increasingly rely on Google Reviews, TripAdvisor and similar rating services, stars can often be the only criteria on which they base decisions, even an important, complicated one like which MA plan to choose.
“A ½-star drop in our ratings would be the equivalent of a $30 million loss,” an Rx Savings Solutions (RxSS) regional health plan client with a five-star MA plan told us recently.
Thankfully, his was not among the 20% of MA plans that lost star revenue for 2023. A year ago, more than two-thirds of all MA plans earned four stars or higher. Barely half of them did for 2023.
The Way Upward
Without delving too deeply into the myriad categories, sources and factors that play into how Medicare calculates star ratings, this much is clear:
- 54% are based on patient experience and administrative measures.
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores now make up nearly one-third of overall star ratings; 19 measures are medication-related.
- Patient Experience/Complaints scores have doubled in weight, from two to four.
Pharmacy is an integral, frequent and repetitive aspect of a member’s experience with a MA plan. Naturally, it is often a huge contributor to satisfaction, or lack thereof.
Unlike survey questions on factors mostly outside a plan’s control—such as how a member feels about their personal doctor or the specialist they saw most often, or how quickly or easily they could get needed care—medication- and service-related issues can be easier for a plan to address and drive improvement.
Take these questions, for example:
“In the last 6 months…
- How often was it easy to get medications your doctor prescribed?
- Did you delay or not fill a prescription because you felt you could not afford it?
- In the last 6 months, how often was it easy to use your prescription drug plan to get the medicine your doctor prescribed?
- How often did you and your personal doctor talk about the prescription medicines you were taking?
- From 0-10, what number would you rate your prescription drug plan?
- Did you get information or help from your health plan’s customer service?
- How often did your health plan’s customer service give you the information or help that you needed?”
MA plans can directly influence the answers in a positive way simply by offering a service like RxSS. How?
- With both digital decision-support tools and expert personal guidance toward more affordable prescriptions and convenient fulfillment options, members are more adherent to medications they need for better health outcomes.
- Every RxSS member can access a detailed medication report showing all medications taken in the past 6 months, when and how often prescriptions were filled, along with available lower-cost options—all of which enable and inform important discussions between MA members and prescribers.
- The RxSS Pharmacy Support team is staffed with licensed clinical pharmacists and certified pharmacy technicians who provide world-class concierge service to help members find the lowest-cost therapies, overcome barriers, and navigate the complex pharmacy benefit maze.
A Safe, Smart Bet
It’s too late to do anything about 2023’s star ratings. They’re out there for the world to see. But it’s never too soon to influence how 1,000 random members who will be surveyed about your plan respond in the years that follow.
Given the litany of star measures that lie outside a health plan’s direct control, providing a pharmacy transparency and decision-support tool is a simple solution that can produce immediate and lasting impact.
The implementation lift is light. Engagement is high, especially among Medicare populations. And considering everything at stake with a plan’s star ratings, the ROI can be incalculable.