High star ratings are gold for healthcare plans in a growing and already crowded marketplace. For consumers, many of whom are shopping for plans without the aid of an agent or broker for the first time, star ratings—like the Summary of Benefits and Coverage—provide a visual snapshot of plan quality, allowing consumers to make apples to apples comparison. For payers, star ratings are a powerful way to differentiate themselves from the rest of the pack.
Because patient outcomes have a profound influence on star ratings, healthcare payers may focus disproportionately on these indicators of plan effectiveness while underestimating the influence that healthcare correspondence has on star ratings. A close look at the criteria for assigning star ratings reveals how important customer perception is when it comes to evaluating plan quality.
CMS assigns star ratings to Medicare Advantage and Part D based on specific categories. These individual ratings are then averaged to provide a summary rating for the plan. Below are the star ratings for Medicare Advantage and combined plans:
- Staying healthy: screenings, tests, and vaccines. Includes whether members got various screening tests, vaccines, and other check-ups that help them stay healthy.
- Managing chronic (long-term) conditions: Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
- Member experience with the plan: Includes ratings of member satisfaction with the plan.
- Member complaints and changes in the health plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
- Health plan customer service: Includes how well the plan handles member appeals.
While patient outcomes and compliance with treatment plans have an undeniable impact on star ratings, customer satisfaction and experience are equally important. Of the five criteria used to determine star ratings, three have to do with member experience and satisfaction (or dissatisfaction).
By raising consumer awareness of plan benefits, offering great customer support, helping members get quick approvals and the right doctors and treatments, and clarifying criteria for making coverage determinations, plan sponsors can improve star ratings. Raising member awareness of coverages and benefits will go a long way toward great service.
To ensure that beneficiaries read and understand their plan benefits, payers must provide correspondence that is:
- Timely – It’s not enough to generate correspondence by mandated deadlines. For consumers to benefit from their health coverage, they need communications that are proactive in explaining their plan’s benefits and how to navigate the customer care system. Selecting a CCM solution with real-time proofing and automated workflows reduces review cycles from months to weeks or days.
- Targeted – People are inundated with communication on a daily basis. To ensure that people read health plan correspondence, they must receive communication that is targeted to their specific healthcare needs, from their Medicare Summary Notice to flyers on wellness incentive programs or medication therapy management materials. Look for a vendor with experienced solutions architects who can help normalize and map variable data to master templates. Your CCM solution should receive data files in multiple formats and apply business rules to customize correspondence for your target audience.
- Delivered through preferred channels: To ensure that customers read their correspondence, payers must deliver communications through multiple channels, so they can send individualized communications through the beneficiary’s preferred method, whether that’s a downloadable PDF on a plan website, a mobile app, or a traditional print mailing. Selecting a CCM solution with multi-channel delivery options is a must.
- Have visual appeal: While the format and content of much Medicare correspondence is tightly regulated, payers do have some discretion when it comes to branding their communications through the use of plan logos and color. Plan sponsors must use what latitude they have to make their correspondence stand out from the mountain of communications beneficiaries receive on a daily basis. Interactive hotspots, business rules, and interactive HTML 5 allow payers to customize correspondence and optimize output for digital presentment
To customize correspondence, payers need an integrated CCM solution that automates every stage of the content life cycle. Manual processes and outsourcing are time-consuming and inflexible when it comes to personalizing communications. Fortunately, CCM technology is evolving to meet the needs of modern healthcare. Thanks to the cloud and SaaS, healthcare payers now have the tools they need to deliver correspondence that meet the demands of the 21st century consumer. Resulting improvements to customer satisfaction and enhanced experience will help plan sponsors boost star ratings and separate their plans from the competition.
Learn how Tango+, the SaaS CCM of choice for leading healthcare payers, can optimize your correspondence.
