Medicare Advantage (MA) plans receive payments from the Centers for Medicare and Medicaid Services (CMS) according to the Star Ratings awarded to them. CMS recently increased the weightage of patient experience, access and satisfaction from 2 to 4 in the assessment of Star Ratings. This implies that MA plans have to work on their patient engagement strategy to boost their Star Ratings.
Improving member experience impacts the cost of operations inversely. By regularly outreaching to members and leveraging care navigation tools, health plans can prevent their members from seeking care from providers that are out of network. Members, in turn, feel more satisfied with their care experience and less likely to use customer service and file complaints.