Health Plan Weekly

Last month marked the end of a three-month data collection cycle that will have a meaningful impact on the 2023 Medicare Parts C and D star ratings, when member experience measures take on a larger weight in star ratings calculations. While it’s too late to make a difference in how members responded to the recent Consumer Assessment of Healthcare Providers and Systems (CAHPS) that reflected the patient experience in late 2020 and early 2021, Medicare Advantage organizations should be focused on innovations that can prevent and resolve issues members face throughout the year to foster more positive feedback for future surveys, advises one longtime stars expert.

As numerous measures based on CAHPS and CMS administrative data move from a weighting value of 2 to 4 starting with measurement year 2021, the increased value of those measures will make up 32% of the overall 2023 star rating on a weighted basis. “We’ve always known member experience was important and we’ve always agreed we need to focus effort and attention in that area, but attaching such a heavy contribution to the overall star ratings to the surveys is the forcing function that most plans are seeing as the impetus for new actions,” says Melissa Smith, who is executive vice president of consulting and professional services at HealthMine, Inc., a Dallas- based member engagement firm.

An annual report on the cost of health care prepared by Milliman, Inc. found that, for the first time in years, health care costs for the average American family fell in 2020. However, experts say that is unlikely to happen again any time soon, as the COVID-19 pandemic caused a steep decline in health care utilization.

The report, the 2021 Milliman Medical Index, found that the cost of health care for an average American family of four covered by an employer-sponsored PPO health plan was $26,078, down from $27,233 in 2019, a decrease of 4.2%. The drop will not be permanent, warn the authors: Milliman projects costs will increase to $28,256 in 2021.

More than one-third of privately insured health plan members in the U.S. accessed telehealth services in 2020, up from just 9% a year ago. The increased use of telemedicine and other digital tools and services is correlated with a jump in overall member satisfaction, a study from J.D. Power shows.

The numbers, contained in the J.D. Power 2021 U.S. Commercial Member Health Plan Study, can’t prove the increase in telehealth, a shift caused by the pandemic, has a causal relationship to improved member satisfaction. But James Beem, managing director for global healthcare intelligence at the data analytics firm, says the study shows “that health plans are becoming more customer-driven and that they came through for member responses” during the COVID-19 pandemic.

Nevada lawmakers this week passed a public option bill, which experts say is the most ambitious and aggressive in a wave of similar policies that have been seriously discussed in recent years. Payers and providers alike objected to the bill, which will go into effect in 2026 and Democratic Gov. Steve Sisolak on Tuesday promised to sign.

Nevada’s public option bill will require any carrier that participates in the state’s Medicaid managed care program or individual exchange to provide a silver- or gold-level public option plan. Premiums for those plans will be set 5% lower than the benchmark silver plan sold on the state Affordable Care Act exchange, and both individuals and small group purchasers will be able to buy into the plan.