Building Trust for Better Medicare Advantage Outcomes

The Key to Higher Star Gap Closure Rates

In the world of Medicare Advantage, building trust with members is not just a good practice – it’s the key to achieving higher Star Ratings gap closure rates. For health plan executives focused on quality improvement and Star Ratings that lead to member satisfaction and retention, understanding the direct link between member trust, engagement and gap closure is essential for success.

In a Medicare Shopping survey1 conducted by McKinsey, only 14% of members were proactively contacted by their health plan to understand their health needs, such as enrollment in a health management program. This engagement gap translated to an overwhelming 86% of members experiencing a poor initial interaction with their health plan.

Why member trust matters and the Star Ratings connection

When seniors trust their health plan, they’re more likely to actively participate in their healthcare journey. This trust directly influences key metrics like Star Ratings, which are crucial for health plans pursuing excellence in care quality.

Star Ratings, issued by the Centers for Medicare & Medicaid Services (CMS), are a measure of a health plan’s overall performance. They reflect how well a plan serves its members in terms of quality care, communication and satisfaction. Higher Star Ratings not only signal excellent care but also impact a health plan’s financial incentives and reputation.

A recent survey of how well Medicare Advantage beneficiaries understand their plans2

Closing the care gap

The term “gap closure” refers to the process of addressing care gaps identified in Healthcare Effectiveness Data and Information Set (HEDIS) measures. HEDIS is a set of performance measures used to evaluate the quality of care provided by health plans. A health plan’s ability to close more care gaps is directly tied to improved Star Ratings.

Trust, engagement and gap closure

To achieve higher Star Ratings in Medicare Advantage, health plan executives can effectively improve outcomes by focusing on building member trust, actively engaging members and diligently closing care gaps. The formula for improved outcomes lies in providing seniors with the right guidance and healthcare navigation resources. This in turn pages the way for enhanced member satisfaction and naturally improves health outcomes.

Strategies for building member trust and closing gaps

1. Healthcare navigation
   Offer a team of dedicated care coordinators and clinicians who serve as a reliable point of contact for seniors. This care team can guide members through benefits, manage authorizations and provide personalized support, fostering a sense of trust. 
2. Information accessibility
   Ensure that healthcare information is easily accessible. Simplify communication channels and make educational materials readily available. Easy-to-understand resources contribute to trust and engagement.
3. Streamlined prior authorization
   Simplify prior authorization processes to remove barriers to accessing necessary healthcare services. An uncomplicated process improves member satisfaction and encourages active engagement.
4. Proactive outreach
   Implement outreach programs to engage seniors in preventive care measures. Regular communication, vaccination campaigns and wellness checks demonstrate a commitment to member wellbeing.
5. Technology integration
   Leverage technology to enhance engagement without alienating seniors. Offer user-friendly resources, telephonic support and one-on-one guidance to facilitate access to information and service.

Elevate Medicare Advantage results with healthcare navigation

Incorporating healthcare navigation into your Medicare Advantage plan presents an unparalleled opportunity for health plans to foster a community of satisfied, engaged seniors while improving Star Ratings performance.