Improving CMS Star Ratings With Patient Pay Services

Improving CMS Star Ratings With Patient Pay ServicesWhile the CMS Star Ratings program has improved Medicare Advantage (MA) health plan performance across most quality measures, health plans have not seen much improvement in the patient experience category, revealing that there is still room for improvement as far as delivering positive member experiences.

In an analysis by McKinsey & Company, it was found that the Star Ratings program is meeting its two main goals – 1) improving performance through higher scores in quality measures and 2) increasing the percentage of MA members enrolled in plans with star ratings of 4 or above. (1)

Data shows that the percentage of enrollees in MA-PD plans with higher star ratings climbed from 24% in 2011 to 73% in 2017, demonstrating that health plans and consumers are positively responding to star ratings. They are taking them seriously when shopping for plans, which means that increasing scores in the patient experience category could help plans compete for new members.

“Concerted efforts to improve in this area could enable insurers to outperform competitors and provide a source of product differentiation in the form of enhanced member experience,” the McKinsey report states. McKinsey recommends health plans implement services that improve the patient-member experience by:

  • Offering “better digital interfaces”
  • Offering pricing transparency
  • Helping physicians to provide better care through incentives and guidance about quality measures
  • Facilitating member-physician interactions that close care gaps

Time to Take Consumer Experience Seriously

A 2018 report examining what kinds of experiences drive customers away showed that “brands are failing to create the positive, emotional experiences that drive customer loyalty.”(2) How consumers experience the payment process is crucial, as people can get very emotional about money. And while star ratings are improving, consumers are moving between health plans at an increasing rate.

With member satisfaction now playing a significant role in revenue generation, health plans must find ways to endear members to them by creating the kinds of experiences that lead to brand loyalty. McKinsey’s analysis shows that there is a very real opportunity for health plans to outshine their competitors by offering unique, positive experiences that can’t be found at other health plans.

Now is the time, and Payspan has the right mixture of solutions to fill in the gap. Payspan is in the business of engaging members, clinically as well as financially, leveraging the largest healthcare payment network to offer flexible payment options and facilitate care gap closures that result in better health.

Learn how Payspan leverages Premium Payments as the foundation to retain members and build brand loyalty.


(1)McKinsey&Company: Healthcare Systems & Services, “Assessing the Medicare Advantage Star Ratings,” July 2018

(2)NewVoiceMedia, “Serial Switchers Swayed by Sentiment: How Bad Emotive Customer Experiences are Costing Brands Billions,” 2018