Improving Patient Experience, While Avoiding a Star Ratings Scandal

The following is a guest article by Suzanne Cogan, Chief Commercial Officer at SPH Analytics.

On March 15, California prosecutors sued Brookdale Senior Living, accusing the largest chain of senior living communities in the U.S. of manipulating the federal government’s Star ratings system.

The lawsuit, reportedly the first of its kind leveraged against a nursing home for submitting false information, brings to the forefront concerns around the Centers for Medicare and Medicaid’s (CMS) Star ratings and patient experience. Are the actual experiences by patients and health plan members accurately reflected in in Star ratings system? And if not, what can health plans, providers, and facilities do to change that, without compromising integrity?

The result of the lawsuit news comes on the heels of a scathing rebuke of the Star ratings system via The New York Timesinvestigative report. Healthcare organizations will face greater scrutiny in the months ahead. But there’s somewhat of a silver lining, within the context of this news.

In May, CMS issued its Contract Year 2021 Medicare Advantage and Part D Final Rule, doubling the weight of patient experience measures used to calculate Star Ratings for health plans. As a result, organizations whose activities and initiatives truly reflect an exceptional patient experience stand to shine when future Star ratings are posted.

It’s time to up the ante on Star Ratings strategies. Here are four areas healthcare providers and health plans should prioritize to boost experience.

#1: Consumer feedback

While every health plan, healthcare network, and physician practice talks up its exceptional patient experience, the truth is that some fall short, and are often surprised when they do. But are these organizations truly listening to what patients are complaining about in email surveys? Are they alerted when a patient raises an issue or cites a problem (e.g., waiting time longer than 15 minutes)? The patient’s perception of a plan or practice is as vital as the quality of care itself: Asking for feedback outside of official surveys (e.g., the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey), can help organizations fix issues before ratings-based questionnaires are dispatched.

#2: Targeted Messaging

Every healthcare organization is reaching out to consumers, whether through postcards, mass emails, or individual phone calls. But consumers aren’t always getting the message. One recent example: Only 37% of respondents polled in an online survey of 2,000 consumers in May said their health plan reached out to them with information regarding COVID-19. Simple steps such as curating outreach to a demographic’s preferences (email, text message, phone call) and taking into account the engageability of a person in their own healthcare can lessen the likelihood that the intended recipient of a message will miss it.

#3: Transparency. Patients should know what they’re paying for, how much they’re paying, and what kind of care and coverage they will receive in return. This is true whether they are evaluating private-duty home care agencies or health plans. Making an effort to give patients access to the exact information they need to make informed decisions will improve satisfaction, and minimize negative feelings of hostility, fear or resentment.

#4: Conflicts of interest. The recent negative reports about Star ratings should be a wakeup call to organizations, that measurement of quality and patient experience should be conducted using measurable and objective metrics and conducted via a certified, neutral third party to avoid any conflict of interest or manipulation of data. Such an approach provides reliable and transparent Star ratings for consumers in other areas of healthcare, such as hospitals and health plans.

Healthcare organizations will undoubtedly face greater scrutiny around their processes, technology and policies. The recent events surrounding Star ratings should be a viewed not only as an alarm but as an opportunity to make critical improvements.

About Suzanne Cogan

Suzanne Cogan has spent over 20 years in healthcare technology and services, focusing on analytics, patient experience, and cross-continuum interoperability – across care settings and between payer and provider. Suzanne currently serves as SPH Analytics’ Chief Commercial Officer where she is responsible for the company’s go to market strategy, including business development, sales and marketing. She is well-regarded for driving exponential growth with rapidly-evolving products, while ensuring client satisfaction and success. Suzanne has a High Tech MBA from Northeastern University and a BS in International Marketing, German and French from Dublin City University.

   

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