Star Strategies: Improving Medicare Ratings with Provider Data

Health plan leaders Will Shrank and Jill Hummel join Ribbon Health CEO Nate Maslak on the Becker’s Healthcare Podcast for a discussion on strategies to improve Medicare Star Ratings using provider data

Over 65 million people across the U.S. are enrolled in Medicare, and many look to Star Ratings for a clear-cut way to understand how different plans measure up. In 2023, Medicare Advantage plans saw a major decline in these ratings. Ratings dropped by 25%, with only 51% of all MA plans achieving a Star Rating of four or more out of five. On top of that, we know that 62% of Americans don’t trust their health plan to provide accurate care options. 

These numbers tell us there’s work to be done to build that trust back up with consumers and improve ratings across plans. Ribbon Health CEO Nate Maslak recently joined the Becker’s Healthcare Podcast with two health plan leaders who have seen the impact Star Ratings can have on an organization firsthand. Will Shrank, an internal medicine physician by training, has served as Chief Medical Officer for numerous enterprise organizations including Humana and UPMC Health Plan. Jill Hummel brings 20 years of health plan experience to the conversation, most recently serving as President & General Manager at Anthem BCBS Connecticut. 

During the episode, these leaders dig into the significance of Star Ratings for health plans, the impact on revenue, enrollment, and retention, and the crucial role of accurate provider data in improving ratings.

Three takeaways for health plans 

• Star Ratings have a significant financial impact for health plans. Star Ratings strongly affect enrollment and retention at a health plan. Every year, members have the opportunity to switch up their Medicare Advantage plan, and they shop around for the best option, with a plan’s Star Rating having a large impact on their decision. When a plan’s Star Rating goes down, they lose current members and have a harder time attracting new members. In addition to the impacts of a drop in enrollment and member retention, Jill explained, “Star Ratings also impact the amount of quality bonuses and rebate percentages that a plan should receive. In order to encourage Medicare Advantage plans to compete for enrollees based on quality, the Affordable Care Act established a quality bonus program that increases payments to plans with higher ratings. And there is really a significant amount of money on the line here.” 
• Health plan leaders should focus on improving the member experience first. “Plans really do care about the member experience,” Jill emphasized. “They want to provide the highest quality healthcare and they want to help their members live healthier lives… So if you're receiving a low Star Rating, then you're really failing in this mission.” For executives working towards improving these ratings, it’s critical to focus on ways to improve the member experience of finding and receiving care. Will added, “If we are not focused on how we take care of patients, how we take care of members, how we take care of consumers, and how we help them through the incredibly challenging process of navigating care in a fragmented healthcare system, what is our job? That is really at the core.” 
• Accurate and high-quality provider data is a key piece of the puzzle. Investing in technology and innovation is a key way for health plans to improve member experiences, and therefore Star Ratings. In particular, accurate provider data enables members to easily search for and find in-network care, which is critical to ensuring members follow through on care recommendations and have positive feelings about the comprehensiveness of their health plan coverage. Health plans should look for a provider data solution that has comprehensive and high-quality data to enrich their own, in combination with technology that can seamlessly ingest, standardize, and customize data from many different sources. Finally, the ability to score and see the accuracy of the data is critical. “It's also really important to know what you don't have. It's not sufficient just to suggest that you have 100 % of all the data that's relevant for every provider if you don't, and no one has all of that data. So there's really an essential transparency feature that's necessary, so you know just how to interpret the data that you have,” Will shared. 

Listen to the full episode, “Star Strategies: Improving Medicare Ratings with Provider Data” on the Becker’s Healthcare Podcast. To learn more about our industry-leading Ribbon Provider Data Platform, get in touch with our team below. 

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