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How healthcare executives can support positive patient care while improving Medicare rankings
When patients need to compare healthcare providers and plans, they turn to online ratings. These consumers want to see how many stars you have, just like they see on Yelp, Amazon, Facebook, and more.
In the United States, that means they’re probably turning to the Centers for Medicare and Medicaid Services (CMS) Star Ratings. The system was first introduced in 2007, took a huge leap forward with improved functionality in 2015, and is now the federal government’s primary way of ranking Medicare-approved services.
CMS Star Ratings offer an easy-to-understand ranking feature that includes most major hospitals and healthcare facilities. Using the same 5-star rating scale that’s widely found across the internet, CMS Star Ratings give an at-a-glance look at any healthcare option.
For major healthcare providers, these ratings can create opportunities and challenges. CMS Star Ratings allow healthcare companies to forge new and deeper connections with potential members.
No healthcare organization wants a poor CMS rating. Here are some key strategies for maintaining a strong star rating while always providing the best possible patient care.
Improve Innovative Offerings Including Virtual Patient Care
Patient care is always evolving, and that’s been more obvious than ever during the COVID-19 pandemic. Communities require remote care options that allow them to communicate with healthcare professionals at a distance.
As the pandemic stretches on, its lasting impact could damage your healthcare organizations’ CMS Star Rating if you’re not careful. Plus, virtual care is quickly becoming the new normal in healthcare simply because patients love it and enjoy engaging with it.
Many major healthcare organizations are finding that tech solutions offer bold new options for improving patient contact that promotes a strong Medicare ranking. Tech solutions address the following key customer service factors in improving 5-star rankings, according to Managed Healthcare Executive:
- Offering online connectivity to and from anywhere in the world
- Providing FAQs to help people understand their care
- Delivering consistent 24/7 service
- Chat support when additional information is needed
- Automated services like reminders that optimize individual patient care
McKinsey calls telehealth a post-COVID reality that no healthcare company can afford to ignore. If your organization can consistently deliver high-quality remote patient care, your health plan members will not only be satisfied by helping recruit future members.
Provide a Strongly Positive Patient Experience
A critical component to attracting and retaining patients is your health organization's ability to provide a consistently positive experience. Leveraging digital tools to provide enhanced virtual care allows organizations' to meet the growing demand for health care, provide patients greater access to the care they need, leading to better outcomes.
Naturally, the more positive the healthcare experience is, the better the star rating. While that might seem obvious, it’s important to emphasize just how much the patient experience is built into the backbone of the CMS Star Ratings.
According to the Centers for Medicare and Medicaid Services, there is essentially no way to maintain a 4 or 5-star rating without providing a highly positive consumer experience. Below is a summary of more than 40 patient experience factors that contribute to the calculation of the ranking.
- Communication with nurses and doctors
- Provider staff responsiveness
- Communication about medication, including pain management
- Discharge and care transition communication
- Environmental factors like cleanliness and quietness
Currently, only two healthcare companies have earned 5 stars across the board, and both of these providers have put the patient experience front-and-center in their missions and marketing. One of the two, Cigna Healthspring, attributes its 5-star status to “incremental sustainable wins” and taking “a holistic approach.”
For example, Cigna has a customer experience team that focuses on issues that directly impact customer satisfaction. When a healthcare company takes time to address challenging obstacles to providing exceptional customer care, the result can be a significant leap upward in the CMS Star Rating.
Focus on Preventive Healthcare and Care Coordination
Although preventive care has been a healthcare buzzword for the last few decades, the CDC reports that the use of preventive healthcare services is still disappointingly low. Approximately 60% of Americans have a chronic health condition that could benefit from preventive care, yet only 8% receive full preventive care.
When healthcare organizations take the proactive step of improving their preventive care outreach, their customers are healthier and happier. The results can be seen in their CMS Star scores.
Going back to the example of Cigna, when this healthcare organization provided additional preventive measures, more than 85% of their members benefited. Specifically, they contacted existing members to advertise options for receiving preventive medication home delivery, plus they offered preventive remote care coordination.
This ensured their customers not only had access to the right preventive medications but also understood how and when to take them properly. The company believes this is one of the many factors keeping its star rating high.
Improve Innovative Offerings Including Virtual Patient Care
Patient care is always evolving, and that’s been more obvious than ever during the COVID-19 pandemic. Communities require remote care options that allow them to communicate with healthcare professionals at a distance.
As the pandemic stretches on, its lasting impact could damage your healthcare organizations’ CMS Star Rating if you’re not careful. Plus, virtual care is quickly becoming the new normal in healthcare simply because patients love it and enjoy engaging with it.
Many major healthcare organizations are finding that tech solutions offer bold new options for improving patient contact that promotes a strong Medicare ranking. Tech solutions address the following key customer service factors in improving 5-star rankings, according to Managed Healthcare Executive:
- Offering online connectivity to and from anywhere in the world
- Providing FAQs to help people understand their care
- Delivering consistent 24/7 service
- Chat support when additional information is needed
- Automated services like reminders that optimize individual patient care
McKinsey calls telehealth a post-COVID reality that no healthcare company can afford to ignore. If your organization can consistently deliver high-quality remote patient care, your health plan members will not only be satisfied by helping recruit future members.
How to Reach for the Stars
A strong star rating is within reach for any healthcare organization. Now’s the time to implement the strategies listed above to ensure your ranking always stays as high as possible.
AMC Health can help. We’re at the forefront of a revolution in healthcare that includes virtual patient care, remote monitoring, and home care options that empower people. We offer a full suite of options that facilitate the efficient use of Medicare while maximizing healthcare resource management.
Schedule a quick 30 minute call with our experts to learn more about increasing your CMS star ratings through high quality patient care.
