Does the annual enrollment period impact STAR ratings and enrollment numbers?

In 2009, CMS began aggregating the domain level quality scores into an overall STAR rating for Medicare Advantage plans and made available to beneficiaries. Beginning in the 2012 enrollment period, contracts were incentivized to receive a high rating through rating-dependent reimbursement schemes.  But what has been the real effect of these changes on payers?

According to market data, after 2010, there has been a significant increase in plan ratings.  This has narrowed reimbursement gaps.

What has become painfully clear is that seniors are paying close attention to the STAR ratings.  STAR ratings directly impact enrollment.  In fact, authors affiliated with CMS conducted a study of almost 1.3 million Medicare beneficiaries. They found a positive relationship – a one-star higher rating was associated with a 9.5 percentage point increase in likelihood to enroll. (SEE “http://media.jamanetwork.com/news-item/higher-quality-rating-for-medicare-advantage-plan-associated-with-increased-likelihood-of-plan-enrollment/”)

This number is actually conservative.  IGATE, a large BPO/ITO vendor in healthcare, has experienced one Payer’s enrollment drop between 30% - 40% based on their STAR rating!  How?  CMS in their push for quality actively promotes moving to 5 STAR plans.  So much so they offer a “5-star Special Enrollment Period” that lasts almost a year allowing members to switch to any 5 STAR rates plan.

One key measure used in the STAR rating system is “customer experience with the plan.”  Remember the phrase “there’s no chance to make a second good impression?” A member’s experience starts with the Annual Enrollment Period (AEP).  IGATE’s experience fixing the AEP can have an immediate and long lasting impact on STAR ratings.  Of course, getting a 5 requires a commitment to 3-4 other key measures (depending on MA vs. Part D).  But without a positive AEP experience, a Payer is doomed from the start.

If you need to boost your STAR rating contact to discuss AEP in a Box at:

healthcare@igate.com 

This proven service is the key to success at one of the largest payers in the country.

David Lung is a Director in IGATE’s Healthcare Services practice.