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2023 Star Ratings: Is Member Experience Your Achilles Heel?

Updated: Jan 25, 2023

As the CMS Star Rating 2023 strategy process kicks into high gear, as in the past, member experience remains at the forefront. The member experience/complaints and access measures being increased means a heightened focus on strategy and planning.

What really defines the member experience is that it is unique for each member. We encourage plans to really define their membership by not only population health statistics, but also education level and what type of healthcare experience or plan type they came from prior to joining your plan, as well as their point of access and the type of care they need from you, your providers, and your customer service teams.

How May It Work?

For example, let’s look at a newly diagnosed, insulin-dependent diabetic. This member will most likely be overwhelmed by their disease and the new requirements to manage it - use of insulin, new diet requirements, new costs they may not have had in the past, and a new dependency on their primary care or endocrinology provider. Having a new diagnosis of chronic disease - let alone one that requires monitoring throughout the day, ongoing medications, and revising your whole eating and exercise pattern - is so overwhelming that most people choose to focus on only one or two items to make their life manageable.

Many diabetics, if they do not have a great provider alongside of them to support their new journey, will operate from a place of fear or lack of understanding that shapes their member experience and impacts their opinion of the healthcare they receive EVEN IF the health plan is providing all needed care through the benefit structure.

How Should Plans React?

To support member management, Stars strategy, member experience, access to care and member satisfaction, plans may want to consider adopting a process to identify and assign an "age" and "complexity" of a diagnosis (especially for very complicated, costly ones from a member perspective) and providing special support and education beyond what you have today in traditional care management, customer service, and member education offerings.

As a result, these members will be more compliant with their disease state, understand how to use their benefits to truly “benefit” their disease, and are more likely to stay with the plan because of this experience.

For more thoughtful strategies and positive member experience for Star Ratings



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