Medallia Medicare Stars Solution Strives to Improve Patient Experience Ratings

Consumers, Health Plans, and Providers All Stand to Benefit from New Data Dashboard

Medakkua Medicare Stars product launch

Patient experience measurement reveals dynamic tensions and differences in the motivations behind what healthcare organizations measure for and why. For some it reflects the strategic pursuit of excellence in improving processes and outcomes, while for others it is done to meet administrative requirements that have significant financial implications.

The patient experience (PX) mindset influencing industry strategy seeks to overcome limitations with traditional survey methodologies, their focus on discrete episodes of care, and resulting use of outdated data to be better able to provide actionable information that can lead to sustained improvements. The need to enhance data liquidity, as well as ensure the timeliness and broad applicability of data, are high among the factors driving the future of PX measurement.

At the 2022 Elevate PX Conference, Toni Land, Medallia’s Head of Healthcare Experience, spoke on a panel providing vendors’ perspectives of clients’ increasing intentionality around data. Rather than needing more data, their focus has been shifting toward needing quality data that is actionable. There is also a focus on meeting people where they are, and communicating with them in the way they prefer and, through that, being in a position to obtain data in return to inform actions that lead to change and improve outcomes in multiple ways for patients and families, as well as team members. Important in that regard is to focus on the role of lead measurements of activity that indicate progress toward achievement of goals, rather than lagging data that report whether a goal was actually achieved.

Medallia has released a first-to-market solution designed to help health plans proactively improve Medicare Star ratings. The Medallia Medicare Stars Solution enables plans to stay continuously informed on member experiences, and to obtain unified views with insights that can facilitate faster actions to improve overall patient experience. To date, this capability has proven challenging to achieve because of silos within organizations that have prevented creating a unified view of patient feedback and experience data. The Solution dashboard now allows plans to connect Stars member experience measurements and Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey questions to real-time signals, to provide insights across the entire member journey and into actions that can improve patient experience and Stars ratings.

The United States was the first country to implement nationally-mandated patient-reported measurements. Since launching in 1995, CAHPS results have been increasingly used to support health plan accreditation, as well as consumer choice of care providers, services, and health plans. In 2010, the Patient Protection and Affordable Care Act (more commonly referred to as Obamacare) mandated that the Centers for Medicare & Medicaid Services (CMS) establish several public reporting and payment programs based on information collected by CAHPS. The Medicare Health Outcomes Survey (HOS) has been included as a quality indicator in Medicare Advantage Quality Bonus Payments since 2012. In addition to contributing to the quality bonus payments made by Medicare to plan providers, HOS data is used for Medicare Star ratings.

Today, the Medicare Star ratings reflect the experiences of people enrolled in different types of Medicare plans, and are used by consumers to compare local plans during open enrollment, as well as to encourage plans to compete based on quality. Quality ratings are based on about 40 performance measurements, including process indicators (e.g. screenings), outcome indicators (e.g. blood sugar level for diabetes), patient satisfaction (e.g. rating of health plan) and timeliness of appeals decisions. Approximately 80% of Medicare Advantage enrollees are enrolled in a plan that has at least a four-star rating. Moving forward, member experiences are an increasing weighted component of Star ratings, and plans will be required to maintain positive patient experiences to achieve 4- Star or greater rating.

Patient experience matters to health plans and providers because it impacts their bottom lines. Organizations can gain or lose new customers based on patient experiences either shared person-to-person or via reviews online. Approximately 61% of patients consult online reviews when choosing a doctor, and four stars is the minimum rating that patients consider acceptable in making medical-related choices. Among the main factors impacting PX are: customer service, communication, and wait times. A study of online physician reviews found that the overwhelming majority of customer complaints (more than 90%) are about service rather than the medical care itself. Communication is a frequent topic of negative feedback in just over half of physician reviews online, and more than one-third of physician complaints online are related to waiting rooms or wait times.

Health plans have a strong financial incentive to monitor and optimize member experience in real time using the Medallia Medicare Star Solution. Plans that receive at least four stars receive additional quality bonus payments from Medicare. Kaiser Family Foundation reports that between 2015 and 2021, the total annual bonuses to Medicare Advantage plans nearly quadrupled, rising from $3 billion to $11.6 billion, with the average rebate per Medicare Advantage enrollee more than doubling. Compared to individual and special needs plans, employer-sponsored plans accounted for the largest share of bonus payments relative to number of enrollees. UnitedHealthcare and Humana, which together account for 46% of Medicare Advantage enrollment, have bonus payments of $5.3 billion (46% of total bonus payments).

Author Information

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Andrew Broderick is a Senior Analyst contributing to Dash Research’s CX Advisory Service as well as Dash Network’s ongoing editorial coverage of Healthcare CX and Patient Experience. Based in San Francisco, Broderick has more than 20 years’ experience in technology research, analysis, and consulting, including an extensive background in digital health technologies and business practices.


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