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Hard as it is to believe, the end of the year is just a few short months away. For health plans looking for ways to increase quality ratings in Q4, it may seem that it’s already too late to make a push for a higher score, or even maintain current scores. It’s not.

CMS releases its 2020 Medicare Advantage Star Ratings on October 11, 2019. While the 2020 ratings are set, there’s still time to implement gap closure programs and effectively boost quality performance impacting 2021 ratings. It’s a step health plans should undertake for five key reasons:

  1. Connect with hard-to-reach members. Improving quality measures helps connect with those members who may historically be hard to engage due to inherent social determinants of health (SDOH), bringing them access to much-needed health services.
  2. Reach members more who are more likely to respond, but who perhaps haven’t participated due to simply forgetting, busy schedules, etc. A simple reminder – whether via text message, email, IVR call or letter – can encourage members to take part in any number of gap closure programs.
  3. Improve quality incentives. Medicare Advantage plans that score 4 stars or above can receive a 5 percent Quality Bonus Payment.1
  4. Increase member enrollment. Achieving just a one-star higher rating is associated with a 9.5 percent greater likelihood of member enrollment.2
  5. Generate plan revenue. For plans with 3.5 stars, improving one measure can increase revenue by $2 PMPM on average.3

How to Get Started

BioIQ clients have had success implementing programs that target members most and even least likely to engage in recommended health screenings, such as diabetes, colorectal cancer (CRC), cholesterol or even flu immunizations.

The key is leveraging data and advanced analytics to identify those people most, and least likely to respond to available screening programs, and then to tailor outreach according to their needs and communication preferences. For example, a close look at a plan’s historical data may show that busy MA plan members are less likely to get to doctor visits for screenings, but they are very likely to return direct-mail testing kits or complete an immunization at a retail pharmacy while out running errands.

To learn more about how plans can improve their quality ratings, reserve your spot for a webinar on October 17 at 1 p.m. ET with Alvonice Spencer, BioIQ’s Senior Director of Innovation and a former Stars Quality Director. He’ll walk through strategies health plans can leverage to increase ratings in their Q4 push to the finish line.  He’ll also offer some essential insights and real-world actions, including:

  • How health plans are taking a new approach to member outreach programs with tailored interventions
  • Ways to redesign programs to move members from awareness to action by the end of the year
  • Trends in how measures have evolved over the years


Webinar - Last Mile Push: 5 Ways to Boost Quality Ratings

End Notes

1.The Centers for Medicare and Medicaid Services. (2018, February). Advance Notice of Methodological Changes for Calendar Year (CY) 2019 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2019 draft Call Letter. Downloads/Advance2019Part2.pdf

2. The Journal of the American Medical Association. (2013, January). Association Between Medicare Advantage Star Ratings and Enrollment. https://jamanetwork. com/journals/jama/fullarticle/1557733#qundefined

3. Park, Y. (2016, June). Value of One Star Rating Measure.

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