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Medicare’s Ratings Update Shows Growing Focus On Patient Experience

Medicare's Ratings Update Shows Growing Focus On Patient Experience

Gregory Gurbikian

Forbes Finance Council | Membership (Fee-Based)

Money

President/CEO at Healthcare Solutions Direct, LLC, a nationwide insurance agency focused primarily on the retiree health market.

Reviews and user feedback are two essential drivers of how people select products. In fact, 90% of online consumers feel their buying choices are influenced by product reviews. Most of the time, we think about this statistic as it relates to physical products. We look at reviews on Amazon or other big online stores before making a purchase, but reviews matter everywhere.

Taking this into account, Medicare is making changes to how it values the experiences of its members. Placing more weight on member experience and complaints, the Centers for Medicare & Medicaid Services (CMS) is updating its Five-Star Quality Rating System to better reflect the patient experience.

Although these changes won’t take effect until 2023, according to an article by HealthLeaders, “consumers will be asked to consider their perceptions about their plans beginning in the latter half of 2021.” The article notes that since Star Ratings both help consumers decide which plan they want and impact plans’ eligibility for quality bonus payments, the scores matter a lot.

Perhaps the biggest area where Medicare plans can start improving is in information and communication. A study conducted by J.D. Power found that this particular area is weak when it comes to member satisfaction. This is an issue as communication is an essential area when it comes to a member’s experience since Medicare is often complicated to fully grasp.

Although these changes won’t take effect until 2023, according to an article by HealthLeaders, “consumers will be asked to consider their perceptions about their plans beginning in the latter half of 2021.” The article notes that since Star Ratings both help consumers decide which plan they want and impact plans’ eligibility for quality bonus payments, the scores matter a lot.

Perhaps the biggest area where Medicare plans can start improving is in information and communication. A study conducted by J.D. Power found that this particular area is weak when it comes to member satisfaction. This is an issue as communication is an essential area when it comes to a member’s experience since Medicare is often complicated to fully grasp.

One way I believe companies can improve the customer experience is to better communicate the basics of each policy. From my experience, enrollees are often drawn to the $0 monthly premiums offered by plans as well to things that Original Medicare does not cover, such as dental, vision, hearing and in some cases gym memberships. Communicating that some of these additional benefits can come with limitations would help an enrollee be better prepared when they need to use these services. 

Another common area I see that could be improved upon is to better inform enrollees about plans’ networks and service areas, and what services may require pre-authorizations under the plans. Having a better understanding of a plan’s network and how the referral process will work would help the enrollee better navigate their health insurance. This would, in turn, improve the customer experience and avoid any misunderstandings. 

The good thing overall is how much value CMS is putting on the customer. These changes demonstrate a desire to make Medicare more user-friendly for members, which in turn will make it easier to find a plan that both works for an individual’s needs and makes them feel good about purchasing it. In a world where user feedback is only becoming more important, this step lets Medicare members use their voice to impact the future of their health coverage and keep others in the loop about what options really are the best.

 

The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation.

Gregory Gurbikian

President/CEO of Healthcare Solutions Direct, a nationwide insurance agency focused primarily on the retiree health market. Read Gregory Gurbikian’s full executive profile here.

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