Breaking Free From a 3-Star Rating: A Strategic Approach to Elevate Your Health Plan
As the CEO of ReferWell, I recognize the challenges health plans face in striving to achieve higher Star Ratings. Remaining stagnant at a 3-Star level not only limits access to quality bonus payments but also hampers your ability to attract new members and diminishes overall plan reputation. There’s no quick-fix, silver bullet here: Elevating your Star Rating requires a strategic, holistic approach that drives member engagement and satisfaction throughout the year.
Understanding the 3-Star Plateau
Several factors contribute to health plans being confined to a 3-Star Rating:
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 member satisfaction, care quality, and health outcomes – prerequisites to improving Star Ratings.
Implementing Year-Round Strategic 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 risk 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 passive one-way 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.
Charting a Roadmap for Improvement
While technology plays a vital role in facilitating member access to care, true engagement that engenders satisfaction goes beyond digital solutions. It demands a carefully crafted strategy that prioritizes taking action to deliver 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 reduce member abrasion (created by today’s approach of launching numerous, unconnected, and unaware contacts) but can address specific needs within a cohesive experience that enhances member satisfaction, boosts health outcomes, and ultimately drives higher Star Ratings.
Our Commitment to Excellence
At ReferWell, we are deeply committed to empowering health plans to break free from the 3-Star plateau and achieve higher Star Ratings. Our solutions are designed to simplify the complex, enabling health plans to efficiently connect members to the care they need, when they need it. By facilitating year-round outreach and seamless care coordination, we help health plans deliver measurable improvements in member satisfaction, health outcomes, and Star Ratings.
Inspired by insights from ReferWell's article on advancing health plan Star Ratings