One in Five Patients Use CMS Star Ratings for Healthcare Decisions

August 9, 2018 Jeanette Stern

Patients are either unaware of the CMS star ratings or do not know how to use them to make healthcare decisions, a new survey shows.

From Sarah Heath via

 - Only about one-fifth of Medicare Advantage beneficiaries are familiar with the CMS star ratings that rank payer coverage, according to a recent HealthMine survey. This finding runs counter to the agency’s intentions for the star ratings to drive patient empowerment in making informed healthcare decisions.

In a survey of just under 800 Medicare Advantage members, HealthMine determined that only 22 percent of members are knowledgeable about the CMS star ratings system. Of those respondents, 51 percent had used the star ratings to make a decision about their healthcare plan.

CMS established the health plan star rating system to help patients understand the health plans available and make informed decisions about them. The agency uses the familiar five-star likert scale model to ensure plan assessments are simple for patients to understand.

Despite the innately patient-facing aspect of the star ratings, a total of 78 percent of Medicare Advantage patients aren’t aware of them or do not know how they work. If offered adequate patient education on the matter, 75 percent of respondents said they would use the star ratings to determine their next health plan enrollment.

Ironically, patients are largely choosing the highest-rated health plans, whether or not they use the star ratings. In 2014, just about half of enrollees chose a health plan with a star rating of four or higher. That number increased to 68 percent by 2017, according to reports from CMS.

The use of star ratings will likely only increase as more patients become involved in their own healthcare, according to HealthMine CEO Bryce Williams.

“Awareness of Star ratings and their importance in plan selection will only increase,” Williams noted. “Plus, with ten thousand new Medicare eligible persons per day who are technologically proficient, leading plans are doubling down in strategic investments to enhance the customer experience. They are rolling out easy-to-use digital tools to communicate with members, and the new generation of Medicare Advantage beneficiaries have a greater propensity to use them. Assuring that the digital data is captured and used to meet Star ratings measures is critical for Medicare Advantage plans.”

Star ratings are an important patient tool used throughout the industry. CMS also uses the star ratings systems to rank hospital quality, allowing patients to make informed decisions about where they will receive care. This is a part of the agency’s mission to put more control back in the hands of patients, allowing patients the freedom to make decisions about their own healthcare.

CMS hospital star ratings do come with a bit of pushback, as some industry groups say the five-star rating is reductive to the nuances of delivering high-quality, patient-centered care. However, CMS maintains that five-star rankings are essential for making these assessments understandable for the patient.

“It can be overwhelming when consumers are faced with having to choose a health care provider, such as a hospital, nursing home, or physician,” said past CMS Deputy Administrator for Innovation and Quality and Chief Medical Officer Patrick Conway, MD. “Providers differ in the safety and quality of care they give, and having quality ratings available to compare providers can help consumers make more informed health care decisions. That’s why the Centers for Medicare & Medicaid Services (CMS) is committed to making it easier to use the information on our Compare sites.”

Ultimately, the benefit of the five-star ratings lay in the ability for the patient to understand them. Patients encounter five-star ratings in other walks of life, making it easy for them to use that representation to make a care decision.

However, this most recent evidence from HealthMine shows that few patients are familiar with the star ratings and similar ratings. While it is near certain that most patients will understand what the CMS star ratings represent, it will be incumbent on the agency to make sure patients are aware that the star ratings are there as a resource as they make decisions about their health plan coverage.

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