CMS star ratings for health plans have always considered exceptional member satisfaction when measuring quality healthcare. However, changes to the star rating criteria in 2021 make a positive member experience more critical than before.

How will these changes affect your plan’s star rating and funding? How can you improve your plan’s member experience? Let’s dive into the details.

Overview: CMS Star Rating

The Centers for Medicare & Medicaid Services (CMS) annually evaluates health plans using the CMS Five-Star Quality Rating System. Dozens of quality and performance measures are used to assess each plan across five key areas:

• Member experience
• Customer service
• Staying healthy
• Chronic conditions management
• Member complaints

Why it’s important to get a high star rating

Plans that receive an overall rating of at least four stars receive additional quality bonus payments from Medicare. The higher your health plan’s CMS star rating is, the larger your government-paid bonus will be. These funds may reduce cost-sharing or cover the cost of providing supplemental benefits.

Between 2015 and 2021, the total annual bonuses to Medicare Advantage plans have nearly quadrupled, rising from $3.0 billion to $11.6 billion.

2021 CMS Star Rating changes – member experience weight increases from 1.5 to 2

In FY2021, the weight of importance assigned to member experience increased from 1.5 to 2 in the star rating system. Delivering above-satisfactory plans year-over-year can be challenging, but there are opportunities providers can seize for continued growth. One way to improve the member experience is by strengthening your language services program.

Using language services to provide a superior member experience

The member experience is measured through surveys. Survey questions ask members to rate their satisfaction with their doctor and the healthcare received, as well as the ease they experienced when scheduling a service.

Clear communication is essential to providing a positive member experience. Scheduling services, effectively sharing medical information, understanding diagnoses and treatment, or clarifying plan information can be challenging even if the member is a native English speaker. You’ll need interpretation and translation services to patients who are limited-English proficient (LEP) to help them overcome language barriers.

When examining how you can enhance your language services, consider these factors:

• How long does it take to reach an interpreter? A streamlined process can help providers connect with an interpreter to communicate with members quickly.
• Does the interpreter know healthcare terminology? Trained interpreters with strong vocabularies can help you improve your First Call Resolution rate.
• Is the Language Service Provider HIPAA-compliant? Protecting your members’ privacy is crucial to providing a valuable experience.

How can CyraCom help?

CyraCom understands what health insurance providers like yours need: we serve eight of the top ten largest health plans, and our rates are among the most competitive in the industry. We support health plans by:

• Investing in a dedicated workforce management team to monitor call volumes and schedule employee interpreters in times when client demand is highest. This helps prevent your agents and members from waiting for an interpreter to become available, keeping Average Handle Time in check for non-English calls.
• Hiring thousands of employee interpreters. Unlike independent contractors, employee interpreters can be lawfully trained. Our standardized training teaches accurate and complete interpretation best practices, and that these results are likely to improve your member satisfaction among non-English speaking members.
• Maintaining quality accreditations from the International Organization for Standardization (ISO). In addition to protecting our partners’ data with the ISO 27001:2013 - Information Security Management certification, CyraCom is recognized for our Quality Management Systems, Medical Device Translation, and Translation Services.

Our team can help you explore additional opportunities to improve your plan’s member experience. Contact Steven Cook or Kelleen Kaden for more information.