The 5 Star Health Plan's Secret To Quality Improvement

October 4, 2016

5 star health plans are focused on quality improvement and member engagement. These plans want to help members get the most out of their health care benefits. This includes being in touch with healthcare and the needs of members. When health plans achieve 5 stars, they show that they have the design and implementation of technology in place and are providing quality solutions to their members.

What is the 5 Star Rating?

Medicare has a five star rating system in place. It measures how different health plans perform in order to help consumers decide which plan is right for them. There are many options available, and the Medicare Plan Finder tool provides information when displaying a list of the different plans available within a person's area.

Categories include:

  • Staying healthy

  • Managing chronic conditions

  • Plan responsiveness

  • Member complaints

  • Customer service

Making Improvements to Quality

There are a variety of ways to make improvements to quality. This includes emphasis on each of the different categories that have an impact on the rating system. The use of in-home assessments, for example, provides patients with more insight into their current level of health. They can be encouraged to go for screenings , tests as well as vaccines when necessary.

The assessments can cover a broad range of topics, and the best plans already have these in place. Strategic health plans offer this service to their members in the home or in conveniently located retail clinics to improve quality and boost member engagement. The assessments can then lead to a care management plan that is customized for the member and their PCP to improve their health and healthcare experience.

There is considerable motivation to establish a Quality Improvement program and goals:

  1. Star rating improvement

  2. Policymaker mandate efforts

  3. Cost savings effort

  4. Member engagement

Care management programs have the ability to meet multiple needs. When the plans are created for members, it helps boost star ratings dramatically.

The Importance of Star Ratings

Star ratings play a vital role when it comes to people determining what plan they are going to choose. All of the star ratings are clearly found on the Medicare Plan Finder tool, which means that the rating cannot be hidden.

While the star rating is only one factor to look at, it can tell consumers a lot about what they need to know about the insurance carrier. It will guide their decision towards choosing one plan over another.

For plans that have only one or two stars for three years in a row, the plan will be flagged as low performing. It looks like a caution sign, and it will prevent people from being able to use the Plan Finder tool to be able to enroll in one of these plans. It can make it more difficult for individuals to sign up for the health care services that you offer, thus causing a drop in enrollment.

How You Can Focus More on Quality Improvement

Five star health plans implement preventative care technology, offer in-home health risk assessments, and place a strong emphasis on customer service. They have embraced the five categories that Medicare uses in order to determine the ratings, and they are actively making adjustments in order to see improvements.

The last thing you want is to have one or two star ratings as it is going to impact your ability to gain enrollment from the website. Focusing on quality improvement by using technology can be the solution you have been searching for.

To learn more about 5 star health plans and how it can lead to quality improvement, contact MedXM today.



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