Imagine: You’re looking for a hotel for an upcoming trip and begin researching. The luxurious resort with countless amenities likely piques your interest more than a two-star motel. And guess what? The same goes for shopping for Medicare.
Star Ratings rank Medicare plans annually by the quality of service consumers receive on a 1-5 scale, impacting your reputation and desirability when consumers search for plans on Medicare.gov. But it’s about more than benefits and prescription drug costs. In fact, social factors such as loneliness impact your ratings more than you know. Take a closer look at the relationship between loneliness and Star Ratings and how it’s shifting in 2024.
How loneliness impacts Star Ratings
The Centers for Medicare & Medicaid Services (CMS) relies on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to understand the patient experience. CAHPS® has the potential to reveal loneliness risks and impact perceptions of care.
CAHPS, loneliness and Star Ratings
It’s important to note that CAHPS® doesn’t specifically account for loneliness, but the chronic condition still has ripple effects on Star Ratings. Due to both the physical changes and changes in worldview that come with loneliness, Star Ratings from lonely individuals tend to be lower. Lonely people struggle with:
- Skewed perceptions of care quality.
- Elevated cortisol and chronic inflammation, which cause physical changes and impact health.
- Misinterpretations of social interactions involved in their care, from facial expressions to tone of voice.
The problem? All of the above impact how lonely individuals use health services.
Solving for loneliness to improve Star Ratings
Achieving better Star Ratings might mean doing extra legwork. Lonely members exhibit lower engagement in health care at the outset, leaving them more prone to cardiovascular disease, hypertension, diabetes and diminishing cognition. When these individuals finally get care, they hit your plan ratings hard. So start by identifying and solving social drivers of health (SDOH) needs to alleviate loneliness, elevate engagement and improve perceptions of care.
SDOH screening for a more tailored care approach
SDOH screening assessments provide actionable data to understand the barriers members face, such as their propensity for loneliness. Whether you ask questions directly or use an app to help, knowing what lonely members need makes it easier to reach them at the right time and improve engagement.
You become somewhat of a marketer in the process, personalizing communication across emails, texts and mail based on individual needs. This represents a shift toward being data-driven, enabling you to collect information about individual experiences and connect people with valuable resources.
But the proof is in the pudding, and prioritizing SDOH:
- Reduces emergency department (ED) visits.
- Prevents medication misuse.
- Connects members to right-fit care.
Remember to look beyond the physical. Factoring in SDOH and loneliness can impact plan ratings and member experience scores.
Adapting to changes impacting Star Ratings in 2024
Much like the economy, Star Ratings are down — so the only place to go is up! The average Medicare Advantage Star Rating dipped from 4.14 in 2023 to 4.04 in 2024. Although that’s relatively small, remember that Star Ratings determine bonus payment eligibility. Your plan must earn a four-star rating or higher to receive a quality bonus payment for service enhancements. Luckily, CMS is making helpful changes.
CMS strives to improve the Star Ratings program
Several Medicare changes in 2024 stand to not only transform care, but also Star Ratings. In the 2024 Medicare Advantage and Part D final rule, CMS finalized a health equity index (HEI) reward, beginning with the 2027 Star Ratings. In doing so, they’re encouraging both MA and Part D plans to improve care for individuals with certain social risk factors, including loneliness.
Importantly, CMS has shifted the way Star Ratings are calculated in the name of fairness. The 2024 final rule, which went into effect on January 1, 2024, reduces the weight of patient experience and access measures, so self-reports of patient experience and care access carry less weight in assessing program quality. They’ve also implemented a new rule for the removal of Star Ratings measures, doing away with the 60% rule that is part of the adjustment for extreme and uncontrollable circumstances such as COVID-19.
Quash loneliness and improve Star Ratings with Pyx Health
The way lonely members regard their health and health care can have significant implications for your plan’s Star Ratings. Take steps to engage these members with the knowledge that their worldview and priorities might be impacted by their condition. SDOH screening can help identify risks and care needs, as can factoring in the provisions of CMS’ 2024 final rule.
Pyx Health can help you improve Star Ratings too. Our team of ANDYs is available anytime to connect members with plan and community resources. Pair this with our compassion-centered app—and evidence-based SDOH screening tools, assessments and engaging activities—to help members understand their own needs.
Ready to give your Star Ratings and member engagement a boost? Start with the right-fit program. Download our checklist today for help choosing an effective solution.
