What are Medicare Star Ratings and why do they matter?

You may have read about Medicare Star Ratings in our provider-facing newsletters, and perhaps you’ve wondered: What exactly are Star Ratings and why do they matter to Blue Cross Blue Shield of Michigan and health care providers?

Let’s take a look at how Star Ratings affect three stakeholders: patients, providers and health plans.

Medicare Star Ratings is a rating system developed by the Centers for Medicare & Medicaid Services to help consumers find the best Medicare Advantage plan for them. Blue Cross Blue Shield of Michigan has two MA plans – Medicare Plus Blue℠ for its PPO members and BCN Advantage℠ for its HMO members.

We want consumers who are shopping for an MA plan to choose one of ours. What’s more, higher Star Ratings lead to increased reimbursement from CMS that go directly into providing more affordable Medicare Advantage plans.

CMS determines its performance ratings by looking at multiple measures that include clinical quality and operational measures, as well as patient experience, as determined by patient survey results. They convert the performance into 1 to 5 stars, with 5 stars indicating the highest possible performance.

We haven’t yet achieved — but continue to shoot for — a 5-star rating. This is clearly a challenge for everyone to work more closely together, including doctors, hospitals and Blue Cross.

CMS assesses a member’s health plan experience through the Consumer Assessment of Healthcare Providers and Systems, or CAHPS, member survey. The survey asks patients to report on their experiences with a wide range of health care services. A large portion of the CAHPS survey is driven by the member’s experience with his or her physician’s team, including such things as follow-up on labs and imaging, and getting timely doctor appointments.

Patient experience: A key driver of Star Ratings

CMS recently increased the weight allotted to patient experience when determining Star Ratings, making CAHPS performance the key driver of overall ratings. Similar to how providers and hospitals (through Hospital CAHPS) are being asked by CMS to provide an improved patient experience, health plans, such as Blue Cross Blue Shield of Michigan, are being asked the same.

We believe that a person who has a good experience with their health care provider and their health plan is more likely to follow up with their doctor to further improve their health and take their medications as prescribed. This allows for greater ease in closing multiple clinical gaps in care.

From a provider perspective, research supports this belief. According to the Agency for Healthcare Quality and Research,* a positive health care experience for patients is associated with positive clinical outcomes and better business outcomes, including improving patient loyalty, maximizing referrals, improving patient compliance and reducing staff turnover.

And, most importantly for patients, a positive patient experience results in better adherence to protocol, better relationships with health care providers and a feeling of mutual respect between them and their medical team.

Improving the patient experience: A team effort

Blue Cross continues to center its efforts on improving consumer experiences, specifically related to the questions about health plan interactions on the survey. And with CAHPS measuring the patient experience across the continuum of care, the survey provides insight into how our provider partners can affect the health of patients and how they assess their overall health care experience.

As we wrote in an August Record article, the entire team at a doctor’s office can affect the health of patients and how they assess their health care experience. We encourage you to focus on improving the patient experience by keeping the following in mind:

• Explain the benefits of getting COVID‑19 and flu vaccinations.
• For patients with hypertension, discuss the importance of checking blood pressure regularly.
• Explain the importance of checking Hgb A1c for patients with diabetes.
• Perform an assessment of your patient’s physical activity and make recommendations on how to improve.
• For Medicare Advantage patients, perform an assessment of your patient’s fall risk, and discuss measures to prevent falls.
• Also, for your Medicare Advantage patients, ask if they have urinary incontinence or urine leakage, and review options for treatment.
• Perform an assessment of a patient’s medication compliance and ability to pay for medications. Change prescriptions as appropriate. Let them know about avenues to explore if they need financial help.
• Let patients know the time frame in which they will receive their lab or test results, how and where to find the results and who and when to call if they haven’t received them.
• Let them know how get an office appointment in a timely manner. Remind them that some appointments are routine or not urgent, so it’s OK to have them scheduled at some point in the future. Help them understand what “urgent” means.

What we’re doing to help

To assist you in improving our Medicare Star Ratings, we’ve implemented a series of initiatives:

• We provide skilled Patient Experience coaches (at no cost to you) to help offices improve their patient experience and train staff on providing excellent service to patients.
• For example, we provide office staff training sessions on the attributes of good service, facilitate patient experience working sessions and provide tips and materials for implementing best practice ideas. For more details, see this article that ran in the Value Partnerships Update earlier this year.
• We also provide training to offices on improving the patient experience and how to close gaps related to Medicare Star Ratings.
• For example, we recently launched an eLearning video series on Medicare Star Ratings that you may have read about in an August Record article.  
• We’ve put together a series of more than a dozen tip sheets called Star Measure Tips. They highlight what you can do to meet the various clinical quality measures, ranging from breast cancer screening to transitions of care. You can access them via web-DENIS by following these steps:
  • From the homepage of web-DENIS, click on BCBSM Provider Publications and Resources, then on Newsletters and Resources.
  • Click on Clinical Quality Corner and scroll down to see the Star Measure Tip Sheets.

By focusing on CMS’ clinical quality measures and the patient experience, you can help make sure that people get the quality care they need when and how they need it.

*Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.