Why Star Ratings Are Important for Providers, Too

Joe Nicholson, DO - Chief Medical Officer

When older adults consider enrolling in a Medicare Advantage (MA) health plan they may consider the plan’s Star Rating as a factor. Medicare’s Star Ratings program is designed to help older adults compare MA plans based on quality and performance. It is a scale from 1-5, with five being the highest, that considers quality and patient experience data, as well as health plan operations.

Healthcare practices can play a key role in patient experience. 

Consider this: When practices consistently provide high-quality care to patients in a timely manner, they can directly impact the number of stars a MA plan receives. Specifically, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) score comprises 38% of plans’ Star Ratings–and 62% of Star-related CAHPS survey questions are geared toward the patient’s experience with their physician's office.

Therefore, participating in plans with high Star Ratings shows that your practice, too, holds itself to high standards. Recognition through the Star Rating system requires dedicated and coordinated care teams working within patient-centered partnerships. It validates not only the health plan but the patient care benefits delivered by the providers who participate in it. 

So, what are some ways providers can positively influence Star Ratings?

Be proactive about scheduling annual wellness visits. Having a defined process for scheduling annual physicals—as opposed to waiting for patients to call and make an appointment—increases the likelihood that your patients will get a physical early in the year. This allows the practice to identify any care gaps, complete further testing, update prescriptions, and provide referrals in a timely fashion—all factors that drive care quality. Proactive scheduling can also convey to the patient that your practice is committed to their health, which can enhance patient perceptions.

Coordinate care with specialists. During the annual physical or other primary care visits, if it is clear a specialist appointment is necessary, try to make the specialist appointment during the patient’s visit, if possible. This increases the likelihood the individual will get in to see the specialist quickly. It also reduces the burden on the patient to schedule the appointment, which can boost compliance and satisfaction. Maintaining open lines of communication with specialists is important as well to coordinate care.

Offer easy ways to get flu shots and other annual interventions. In addition to having a process for scheduling the annual physical, make sure there are methods of ensuring patients receive flu shots each year, as well as other necessary vaccinations. This may include scheduling vaccine clinics where patients come and receive vaccines at a convenient time and place, without having to schedule an appointment.

Survey your patients. Sending out a brief questionnaire to patients about their care experience can help you identify possible improvement opportunities ahead of the CAHPS survey. By proactively addressing some potential frustrations, you can raise your score when the official survey drops.

Take Away:  Remember, the Star Rating system helps older adults and caregivers compare the quality of MA health plans and empowers them to make informed health plan decisions. Star Ratings also help the practices that participate in those plans to stand out as quality providers amongst the sea of practices patients can choose from for their care.