For many health plans, breaking free from a 3-Star rating can feel like an insurmountable challenge. Being stuck in this ratings purgatory not only limits your access to quality bonus payments but also hampers your ability to attract new members and diminish your overall plan reputation. Achieving higher ratings is not just a matter of improving a few metrics; it requires a strategic and holistic approach that will drive your members to take action throughout the year. This blog will explore how implementing an annual programming strategy can help your health plan ascend from 3-Star Ratings to the coveted 4 and 5-Star levels.
Why 3-Star Ratings Persist: Common Pitfalls and Challenges
Health plans often find themselves stuck at a 3-Star Rating due to a combination of challenges:
- Inconsistent Member Engagement: Regular and meaningful interaction with members is crucial for improving satisfaction and outcomes. However, many health plans struggle to maintain consistent engagement, leading to unmet needs and member dissatisfaction.
- Unaddressed Care Gaps: Gaps in care, such as missed preventive screenings or untreated chronic conditions, can significantly impact Star Ratings. Plans that fail to address these gaps often see stagnation in their scores.
- Low CAHPS Scores: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey plays a significant role in determining Star Ratings. Poor performance in CAHPS can be a major barrier to achieving higher ratings. One of the key factors influencing CAHPS results is whether members feel they have easy access to the care they need.
Remaining at 3 Stars carries both financial and reputational consequences. It means missed opportunities for quality bonus payments, reduced competitiveness in the market that limits new member enrollments, and a perception of mediocrity that can drive defections in the next Annual Election Period (AEP). To move beyond this plateau, health plans must focus on key areas that drive Star Ratings, including member satisfaction, care quality, and health outcomes.
Unlocking Higher Star Ratings with Strategic Year-Round Programming
To break free from the 3-Star plateau, health plans need to implement a comprehensive, year-round strategy that addresses every aspect of the member journey—from initial engagement, health assessments and risk adjustment visits to closing care gaps and managing the member experience throughout the year. This outreach framework should extend beyond merely sending messages; it should prioritize delivering exceptional member experiences through an empathetic team and be reinforced by advanced scheduling tools that make it easy for members to access care.
The most effective programs are those that are self-sustaining and continuously evolving. By capturing member stories and tracking and scheduling members for overdue screenings, vaccinations, and chronic disease follow-ups, health plans can make real-time adjustments that deliver measurable ROI while simultaneously enhancing access to care and fostering meaningful connections that are reflected in higher reported member satisfaction.
This approach is powerful because true engagement is about driving action (members visiting providers to receive care) that sparks meaningful change in members’ experience and satisfaction with the plan. When health plans prioritize these actions—whether it’s scheduling appointments, completing Health Risk Assessments (HRAs), or having impactful conversations that empower members to fully understand and maximize their health plan benefits—they lead to tangible, positive outcomes. By integrating these efforts into a cohesive strategy, health plans ensure that every interaction not only meets immediate needs but also contributes to better health outcomes, satisfaction, and, ultimately, higher Star Ratings.
Designing a Roadmap: Essential Programs to Drive Star Rating Improvements
If technology alone could address engagement and dissatisfaction among member populations, the problem would have been solved long ago. While having systems in place to help members access the care they need is essential, true engagement that inspires action goes beyond technology. It demands a carefully crafted strategy that prioritizes taking action and delivering exceptional member experiences. Health plans should implement year-round programs that target specific outcomes—such as engaging and retaining their new members by enrolling them in an Annual Wellness Visit (AWV), improving risk adjustment performance by scheduling visits with their primary care provider (PCP) and specialist visits to begin caring for newly-discovered conditions, and closing care gaps by scheduling members into preventive care visits—because these focused initiatives are key to achieving overall success.
By integrating these programs into an end-to-end strategy, health plans can adopt a systematic approach where each program complements the others. This ensures continuous, proactive, and personalized member interactions that not only reduces member abrasion created by today’s strategy of launching numerous, unconnected and unaware contacts but are able to address specific needs within a cohesive experience that enhances member satisfaction, boosts health outcomes, and ultimately drives higher Star Ratings. Implementing such a strategy allows health plans to stay ahead of member needs, fostering long-term relationships and delivering tangible improvements across all key performance areas.
Just like maintaining personal health, achieving significant progress requires looking at the whole picture. For instance, you could exercise for hours every day, but if you neglect your diet and sleep only four hours a night, your health will suffer. Similarly, addressing member needs in isolation leads to fragmented experiences, poor engagement, and suboptimal outcomes.
Click here to see what a comprehensive end-to-end strategy could look like—one designed to significantly enhance member experiences of accessing care and boost Star Ratings.
How ReferWell Can Help
ReferWell offers a comprehensive, systematic approach that addresses every phase of the member journey, from initial engagement and health assessments to closing care gaps and managing member experience. Our advanced scheduling platform and empathetic Care Navigators ensure that your members receive the care they need when they need it, resulting in improved HEDIS measures, higher CAHPS ratings, and better Star ratings (along with overall better health outcomes).
With ReferWell’s claims-validated 242% ROI, you’re not just investing in a service; you’re investing in a solution that drives measurable improvements in both member satisfaction and Star Ratings. Whether it’s through proactive outreach, personalized care coordination, or strategic year-round programming, ReferWell has the tools and expertise to help your health plan break free from 3-Star purgatory and achieve the higher ratings you strive for.
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Contact ReferWell today to learn how our Care Access Complete Program can help your health plan elevate its Star Ratings, enhance member experiences, and achieve lasting success.
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