Medicare Advantage has become increasingly popular for older Americans, with more than half opting for it over traditional Medicare. However, providers are increasingly under pressure, driven by factors like stagnant reimbursement rates, prior authorization requirements and service denials. As a result, some hospitals and health systems are terminating contracts with Medicare Advantage plans, affecting patient access to care.

The post-pandemic landscape has brought new challenges to the healthcare industry. As patients return to in-person appointments, a higher percentage are presenting with advanced chronic conditions and severe illnesses due to delayed care during the pandemic. This has led to increased utilization and costs for health plans.

Additionally, the Centers for Medicare & Medicaid Services (CMS) has tightened requirements for health plans to achieve higher ratings in the Medicare Advantage and Part D Star Ratings program. Star Ratings, introduced in 2007, have significantly impacted the success of health plans. Higher-rated plans attract more members, which in turn results in a per-member revenue bonus from CMS. Using this additional funding, plans can improve benefits, care management and technology. Meanwhile, lower-rated plans face challenges in attracting new members and improving their ratings due to limited resources.

Improving Star Ratings requires long-term commitment and investment, say AArete Managing Director Darren Ghanayem and Manager Alex Behm in their new guest article for MedCity News, titled “How Medicare Advantage Plans Can Prioritize Quality Amid Continued Turbulence.” In it, they explain several ways in which organizations with underperforming Medicare Advantage plans can start establishing a strong foundation for future long-term success.

Among their recommendations are that health plans should focus on prioritizing member satisfaction and engagement, as HEDIS measures now carry the most weight in CMS’s Star Ratings. Improving customer service, investing in technology and adopting personalized communication strategies can also help make the member experience better. Additionally, health plans should consider leveraging artificial intelligence to provide more tailored and efficient services.

Infrastructure upgrades are another crucial area for health plans aiming to improve their services and Star Ratings. Modernizing data warehouses, data capture methods and data extraction processes can help plans make more informed decisions and provide better care to members.

By focusing on personalized, preventative care and building a strong infrastructure, health plans can improve member health outcomes while also potentially increasing their Star Ratings and driving down costs across the board.

Click here to read the full article, originally published in MedCity News.