paper airplanes fly towards stars

Fall is here, and for health plans, that signals Star ratings season! But this year is unlike any other. As 2021 ratings roll in and you begin making plans for the future, it’s important to recognize that the rules of the game have changed.

Market forces beyond your control—including the significant backlog of deferred care due to the pandemic and myriad new CMS rules—have impacted 2021 ratings and will change your approach to Stars this year and well into the future.

1. Get zealous about engaging members

You know it’s imperative to get members back to care in order for them  to stay healthy. After all, when members miss visits, their health, as well as your HEDIS scores, HCC capture and MLR are all directly affected.

But the deluge of deferred care will likely continue into 2021 as member concerns linger over how to get care safely and how to pay for it.

So intensifying your member engagement efforts must be a top priority. Leverage behavioral science strategies like primary research and modeling to gain deeper insight into your members as individuals–and to any barriers that may be keeping them from care. Are members confused about where or how to seek care? Are they afraid to visit a clinical setting? Understanding how these barriers to care show up differently in your membership can inform how you approach them.

Apply that insight to create a truly personalized experience for members—and adjust your content and channels throughout the member journey to align with each member’s preferences.

A novuhealth ebook

Check out this in-depth analysis of the 2021 Star ratings from Revel, the leading health action technology company that NovuHealth recently merged with

Check out this in-depth analysis of the 2021 Star ratings from Revel, the leading health action technology company that NovuHealth recently merged with

2. Elevate the member experience

In a year when CMS has increased the weighting of CAHPS measures for satisfaction and experience, the pandemic has conversely had a devastating impact on member experience. According to a recent online survey, only one-third of members said their health plan sent them information about COVID-19; and almost 80% of members diagnosed with the virus said their plan had done something to make them question remaining a member. A full 70% said they would switch plans now if they could.

It’s time to redouble your focus on member experience and remind members that you care about them. Here are 3 best practices to let members know you care about their health and are committed to helping them access the care they need:

  • Make it personal. Send frequent, relevant, personalized communications to your members via their preferred channels. To be most effective, use plain language, leverage design elements to improve readability, and explain to your members not just what you want them to do, but why.
  • Refresh their memory. Remind members of the valuable benefits your plan offers. If they haven’t recently engaged with the healthcare system, they may not remember that their plan provides them access to benefits like dental coverage or community resources.
  • Meet members where they’re at. If they’re uncomfortable going to the doctor’s office for in-person visits, educate them about telehealth services or in-home appointments available to them.

3. Take advantage of CMS’s new guidance

Finally, with the new flexibility CMS is offering plans in 2020, you have choices. Take advantage of these new rules to drive member care and plan performance.

For example, CMS has said 2022 Star ratings will be calculated based on data from either 2019 or 2020, or a mix of both. This means plans have the opportunity to cherry-pick their best results for each measure across two years. You can also deploy targeted campaigns that are laser-focused on the HEDIS measures you most want to improve, especially those that didn’t perform well in 2019. You’ll not only boost performance this year but set yourself up for higher Star ratings and bonus payments in the future.

Also, CMS has expanded access to telehealth, increasing both benefits and flexibility for plans. But recent studies show telehealth adoption is lagging in some populations. So be sure to not only offer telehealth where possible—but also educate your members about how to access it, how to use it effectively, and how it can be a safe way to get the care they need.

Finally, plans should take advantage of the delayed HOS survey—which CMS moved permanently to occur between August and November. This change gives plans more time each year to impact HOS scores. Consider a focused program that engages members with positive content that helps them feel better about themselves, their health, and their health plan, such as our Healthy Connections for HOS Solution.

Chat with and engagement expert

Connect with one of our Engagement Strategists to learn how to boost your Star ratings amid the backlog of care and myriad of regulatory changes

Connect with one of our Engagement Strategists to learn how to boost your Star ratings amid the backlog of care and myriad of regulatory changes

About NovuHealth

NovuHealth is the leading healthcare consumer engagement company, driven to improve consumer health and health plan performance. NovuHealth motivates consumers to complete high-value healthcare activities by leveraging its sophisticated engagement platform, proven loyalty and behavioral science strategies, and deep industry and regulatory expertise. Headquartered in Minneapolis, NovuHealth has worked with nearly 40 health plans and served nearly 15 million consumers across all 50 states. Learn more at novu.com.