It’s clear that improving health engagement has an impact on both individual and overall Medicare Star Ratings for healthcare organizations. Understanding the true ROI of healthcare member engagement can be a complex process on its own.
Diving into each engagement program and determining the best areas to improve overall Medicare Star Ratings in the long run is more than a full-time job for most healthcare organizations.
In this post, I’ll examine five ways to identify those measures that will provide the strongest ROI when it comes to improving overall Medicare Star Ratings. At the end, I’ll explain how to calculate your Health ROI right now.
So, how do we improve Health ROI when it comes to Medicare Star Ratings?
1. Crack the Code on CMS Data
Develop a methodology for calculating the ROI of improvements to individual health engagement campaigns. This provides invaluable input to healthcare organizations’ strategies as they determine which measures can make the most impact on their overall Star Ratings.
Obviously, Center for Medicaid and Medicare Services (CMS) data provides the foundation for any ROI analysis on individual health engagement programs. We know that overall Star Ratings are important, as they determine the amount of reimbursement. But diving deep to identify the individual programs where improvements will contribute significantly to the overall rating is the best place to begin.
2. Choose the Best Measures
First, determine where improvements can be made quickly. For every health engagement measure it’s important to understand how much focus is required to make a positive change in participation. Action-based campaigns, where the member is encouraged to do one thing – like getting a flu shot, for example, or a mammogram – are perhaps the easiest to influence with strong health engagement tactics. Identify that “low hanging fruit” as perhaps the first set of measures on which to focus.
Next, it’s important to identify areas where the threshold is very close to the cut point. You’re probably not going to have much luck going from a 1 to a 5 in a year, but small percentage increases can make a big difference in overall ratings.
Focusing on those programs where perhaps your measure is 1-2% away from the cut point identifies strong candidates on which to focus health engagement tactics.
Finally, factor in the “weight” of each category. The type of campaign will determine the weight assigned by CMS, which affects the overall Medicare Star rating calculation. Weights are lower based on the actual transaction involved. For example, a measure that is weighted a “3” will have much more impact than a “1”. An initiative to reduce the risk of falling may not contribute as much to the overall Medicare Star rating as measures to improve mental health.
3. Hedge Your Bets Where Health ROI is Concerned
In the end, we all understand that cut rates are relative. 4-Star thresholds for specific measures are no longer predetermined, but instead are based on complex cluster algorithms and relative scoring. In the years to come they will shift based on the performance of healthcare organizations overall. Therefore, strategies have to be based on our best guess of where those cut rates will be in the coming year.
It’s impossible to improve every measure and almost as hard to predict the combination of measures that will move the needle higher on an overall Medicare Star rating. One thing is certain however – every health organization is striving to improve their ratings.
Maintaining the status quo in terms of Medicare Star Ratings and engagement will be a losing strategy in the long run.
My recommendation is to develop a portfolio of program improvements that takes into account all the factors described above. Which measures are the easiest to impact? Which ones are close to the cut point, and which ones hold the most “weight?”
A health engagement strategy should include a selection of measures that meet a carefully chosen combination of the above criteria. And be sure to include at least a couple of measures in that portfolio that are longer term, and highly weighted. Improving or maintaining physical health measures may be harder to impact, but advanced health engagement tactics that utilize personalization, or even AI, are gaining ground on these “harder” areas every day.
4. Health ROI is More than a Star Rating
It’s important to remember that ROI comes from not just reimbursements, but also the cost savings that have always been the purpose of the ACA.
Data driven healthcare not only shows us how costs are reduced as we earn engagement, it is also providing remarkable information on the cost savings from the results of these measures.
As data becomes less siloed and we learn more about how much money is being saved, it will be easier to add this into the equation.
In the meantime, what we know right now is that lives are being saved. And the value of that contribution is of course, infinite.
5. Start Calculating Your Health ROI
With all of this in mind, it’s critical to start assessing your Health ROI as soon as possible. If you’re interested in getting the true ROI of your Medicare Star Ratings and discovering where you’ll have the most impact, connect with the Icario team. We’d be happy to help you find the right measures to focus on with our Icario Star Navigator™ tool.