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2021 Medicare Star Ratings: What it Means for Member Engagement

The wait is over! Today 400 Medicare Advantage and 55 Part D plans received the final 2021 Star Ratings from the Centers for Medicare and Medicaid Services (CMS). This is always a milestone day for every Medicare organization. Plans who perform well receive higher quality bonus payments and rebates, and have been shown to outperform lower-rated competitors in member acquisition and retention.  

This is also a big day for mPulse as we look at the role of member experience and engagement in determining a majority of each plan’s summary rating. Even in this year’s release where CAHPS and HEDIS data is carried over from the 2020 ratings, we see how CMS changes and increasing Part D competition make a major impact on performance. So, as our team looks at the 2021 data, we are always looking at the implications for the dozens of Medicare plans we partner with and member engagement overall. 

Here are some themes that stand out to us: 

 

Mostly Neutral and Negative Movement for Plans 

The Medicare quality landscape got even more competitive this year, continuing a trend we’ve seen from CMS in recent years to push for more stratification between plans in ratings. While the number of 5-star plans increased by one, the overall number of plans at or above 4 stars declined by a net of 16. While the 2020 ratings saw an impressive 52% of contracts at or over 4, this year’s group will drop to 49% of MA-PD contracts. With many data sources remaining static, a lot of the negative movement plans experience will be due to cut point shifts, weighting updates, and the measures that weren’t impacted by COVID-19 changes.  

This year’s data aside, the number that jumps out the most at us today is 212. That’s the number of MA-PD contracts appearing as “too new to be measured” this time, compared with the 400 actually measured. Established plans have to prepare for these newer contracts to pursue higher ratings with intense focus, knowing that a poor start can be difficult to recover from.  

mPulse is working with both long-standing plans that are evolving their quality strategy to protect high rating, as well as newer contracts that want to compete with highrated plans immediately. The common theme we’ve heard from both types of teams is that they know they need to do more than the standard quality improvement playbook. They’re going beyond traditional engagement channels and provider-relations-centric approaches, using partners like mPulse to differentiate member experience and activate each of their members. Today’s news will only accelerate those trends.  

 

CAHPS Weighting Adjustments Have an Impact 

Member experience is a major topic in Medicare and these 2021 ratings are a reminder of why. This year was supposed to be a transitional period where non-flu CAHPS measures move from 1.5x to 2x weight before eventually moving to 4x in 2022 and 2023 ratings (the measurement year of 2021, coincidentally). But since CAHPS data was carried over from last year’s ratings due to COVID, plans are in the unexpected situation of seeing the same data impact their overall rating more, with good being better and bad being worse.  

While many plans will be frustrated to see CAHPS improvement efforts not reflected today, the work they have done and strategies they put in place now will have a huge impact soon. Plans that have relied on meeting call center requirements and fielding proxy CAHPS surveys are moving towards dedicated CAHPS/HOS strategies and member engagement solutions focused on Member Experience. As we see what a 25% increase in measure weight looks like today, plans are thinking about how they can understand and improve member satisfaction next year, where the weight will increase by another 100%.  

We’re working with our partner plans to create new, conversational touchpoints with members and feed critical experience data back to the entire organization – helping them make decisions driven toward improving CAHPS and HOS scores before the next major weight jump.  

 

Medication Adherence Is Even More Competitive 

As expected, the measures least impacted by the COVID changes were the ones to experience the most cut point movement. These measures represent an important area of focus for plans heading into next year. The Medication Adherence measures were at the top of this list with their traditionally narrow cut points and triple weighting. These measures saw a uniform drop in average MA-PD rating of .1 to .2 stars, and the SUPD measure, 3x weighted for the first time, dropped .4 stars on average. Plans that did well in these Part D measures will be very pleased today since they faced strong headwinds this year.  

Medication Adherence is one of the key measure sets for plans that work with mPulse since so much of success depends on member action. It’s another area where intense plan competition is only going to increase as more plans look to improve adherence in their entire populations and go beyond simple refill reminders. Connecting members to initiatives like 90-day supplies and mail order pharmacy, as well as gathering data on barriers to adherence helps plans improve their measures and make better decisions about pharmacy quality strategy.  

Understanding why an individual member isn’t adherent helps us get the right resource to them immediately via mobile channels while helping build a better understanding of what we need to do to help the entire population improve. That sort of understanding is critical as plans look to deal with ever-higher cut points and even more competitors going forward.  

The 2021 ratings are going to be remembered for all of the unusual circumstances impacting them. But for all of the carried-over data, impending weight shifts, and large number of new contracts, we think they tell a consistent story. Medicare Advantage plans will continue to succeed in large part by how well they engage their members to deliver a differentiated experience and drive vital actions to improve their health. We join our MA-PD customers in looking forward to a more “normal” 2022 rating set, and are excited to deliver solutions to help them reach their organizational goals, create innovative experiences for members, and ultimately better serve the people they care for.  

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    How Leading Payers, Providers, Pharmacies, and Population Health Organizations are Adapting to this Flu Season

    America is about to experience a return to “normal” that won’t be as pleasant as the others we’re all hoping for. This fall, the push to get as many Americans vaccinated against influenza will, as usual, become the primary public health issue in the country. And since the average 20 million illnesses and 400K hospitalizations in mild flu season would hit our healthcare system at a time where capacity and focus must remain squarely on COVID-19, the stakes are higher than years past. 

    This year bring new challenges and obstacle to vaccination that care organizations must work to understand and overcome. The typical assistance from vaccination pushes in schools, workplaces, houses of worship, and other community resources will be absent or reduced. The usual challenges of apathy from young/healthy members, concerns about getting the flu from the vaccine, health education gaps about vaccine safety and importance, and access and awareness barriers will return. But this year they are joined by new obstacles from misinformation about COVID risk from vaccination to worries about entering healthcare facilities. Each individual’s calculation on getting a vaccination will be different this year. The burden for healthcare organizations will extend beyond the typical awareness campaigns – we have to understand each person’s barriers to vaccination and help overcome them. 

    Leading payers, providers, pharmacies, and population health organizations are already adapting their approach to encouraging vaccinations in their populations. Their strategy has shifted from reminding and nudging to educating and activating. New approaches to building health literacy and more engaging content types are already being used to address new and heightened obstacles preventing people from seeking vaccinations. Technology is also playing a powerful role in connecting specific and tailored content to the people that it will impact the mostmPulse’s partners have seen success in solutions that effectively identify and overcome barriers to medication adherence and gaps in care closure. Now they are leveraging our Conversational AI technology to do the same with new flu vaccination challenges caused by the COVID-19 pandemic.  

    Understanding a person’s barriers to action is the first step to helping overcome them. Our approach at mPulse is straightforward: we start with a conversational reminder delivered across mobile channels, and we follow up with questions that either confirm vaccination or simply ask the person what is stopping them. We take answers they give – no transportation, the flu shot gave them the flu once, they aren’t going into doctors’ offices during a pandemic, the vaccine makes COVID worse – and process them in real time using Natural Language Understanding (NLU). We match the individual’s barriers with configurable content that the plan, provider, or other organization chooses to address that issue: safe rides to a clinic, fotonovelas on vaccine education, locations for drive-through vaccinations, whatever the organization needs to connect to the member with that specific challenge. The barrier assessment creates additional opportunities to educate members and drive action, while generating actionable, real-time insights about what is keeping your specific population from getting vaccinated. 

    Getting some individuals barriers to vaccination does more than just help connect them to resources – we can use data and identified barriers to understand the broader population and align strategies to help them. When we compare identified barriers with key data like member age, location, engagement history, health status, demographics, preferred language and culture, we can help organizations begin building personas that likely share common barriers. This allows for tailored content even to members that do not engage at first or have been previously hard-to-reach by provider or payer outreach. So responses that identify barriers for a portion of members can help improve the vaccination outreach to the rest.  

    Whether it’s using the mPulse solution or taking a more manual approach with live callers, a conversational strategy will be key this flu season. Simply reminding your population that it’s flu season and vaccines are important will not be enough. When a member or patient who might typically get vaccinated, but is hesitant this year, can express their worries and receive relevant follow-up, they feel heard and they are more likely to act. And a younger, healthier member who may skip flu shots normally may be much more aware of the importance of building community immunity this year, and just needs to know where to go. Tailoring content to them, based on what they tell us is stopping them, gives us the best chance to help. The task of getting people vaccinated against influenza is familiar, but this year’s new challenge of understanding how individuals are reacting to vaccination strategies during COVID s will require this kind of conversational approach. 

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    Digital Fotonovelas for Flu Engagement: A New Approach for a Unique Year

    The 2020-21 flu season poses new challenges in addressing COVID-19 alongside traditional challenges driving flu vaccination. Flu season for most adults typically begins around November and plans push reminders to have members schedule their flu vaccination. However, with COVID-19 as an ongoing concern, healthcare experts are suggesting getting the flu shot as early as September 2020, to at least quell the brunt of one virus while trying to manage the other. In addition, members who take precautionary measures early-on will alleviate pressure on hospital systems that have been carrying the weight of COVID-19.

    Organizations must enhance their flu engagement strategies to address new concerns and barriers to vaccination this year and educate members quickly on new topics. With the right tools, health plans can take a multi-angled approach to member outreach that will help address and overcome several barriers at once. mPulse has been working with our customers to roll out new content and technology to help handle the challenges of this flu season—read about our 2020-2021 Flu Engagement Solution here. The solution incorporates digital fotonovelas. These are typically a 6-frame comic-style story portrayed with lighthearted graphics, that deliver important content to across demographic segments at scale. The story-style graphic can deliver vital educational flu resources directly to members’ mobile devices, through SMS and link-to-web, using members’ preferred language. This tool has been used in key healthcare use cases in the past, (e.g., value of HPV vaccines and diabetes self-management) and has proven to be a complementary route of communication when utilized with a text messaging approach to member outreach.

    mPulse Mobile first deployed fotonovelas as a bi-lingual visual tool during the onset of COVID-19 as a part of the COVID-19 Rapid Rollout Toolkit solutions. The goal was to adapt a traditional and effective style of print media into digital format delivered through SMS, to help overcome health literacy barriers during a time when the spread of healthcare information was urgent and needed to be disseminated quickly at scale. The 6-frame graphic style of communication, paired with a series of check-ins via SMS, helped our plan and provider partners build health literacy around social distancing, basic hand hygiene, and keeps multi-lingual populations informed with accessible and coordinated outreach via mobile channels. The goal of this capability was to successfully assess members’ health risk and respond through text dialogue and educational fotonovelas appropriate for each member’s situation, in their preferred language. We’ve seen that when matched with strategic member outreach, fotonovelas can be a tool that offers an access point to fill in gaps in knowledge that drive healthy behavioral change even during a time when many are hesitant to seek out healthcare in person.

    Fotonovelas also present an opportunity to address individual-level barriers and inaccurate health beliefs related to COVID-19, and flu vaccines in general. They can help address education gaps surrounding available flu vaccination resources during the pandemic while promoting health literacy. Paired with text message dialogues, plans and providers are able to uncover new barriers that may have prevented members to seek flu vaccinations early and match members to follow up content, including fotonovelas, that addresses those specific challenges.

    During the 2019-2020 flu season, mPulse powered over 15,000,000 flu vaccination touchpoints across Medicaid, Medicare and commercial plan populations. The solution achieved a 2x increase in recorded flu vaccination rates in a large Medicaid population*. This year, as the flu season approaches with the added layer of COVID-19, plans and providers will need to more agile and responsive than years before.

    For that reason, fotonovelas have become one of the core capabilities in our Flu Vaccination Solution for 2020-21. Fotonovelas engage a range of core population groups, including key multicultural segments with configurable content and versioning that enables matching to specific personas and demographics that can be updated over time. They can be a touchpoint that alerts members of appointment reminders, vaccination site locations and educational services. But the most powerful aspect of this form of outreach is the ability to tailor content based on an understanding of members health beliefs, in members’ preferred language and through their preferred channel. By listening to member responses to automated text conversations and understanding what they need to hear in order to get vaccinated, health care organizations can gather insights and deliver tailored and engaging outreach at scale. Because the solution is available on SMS and Link-to-Web it has the ability to reach a wider population at scale, meeting members where they are, taking pressure off of the member to seek out information during the height of the pandemic and flu season.

    In a year of “unprecedented situations” the 2020-21 flu season is yet another that will require healthcare to evolve its approach. The reach, engagement and rich content provided by our fotonovelas strategy is a natural fit for the unique challenges of this flu season. Healthcare organizations know they have to do more this year than a strategy of 1-way reminder outreach and reliance on employer, church, or school vaccination drives. By creating conversational touchpoints around flu vaccination and supporting members with differentiated and rich content, they can elevate their engagement strategy to support the populations they care for.

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    Managing Influenza in 2020: Cutting Through Pandemic Confusion

    It probably won’t come as a surprise to hear that flu season is just around the corner. Nor that it promises to be all the more challenging due to COVID-19. This season is also taking on a new urgency—as the potential for serious complications ramps up if patients contract flu and COVID-19 at once.

    Flu season is tough to manage at the best of times. Developing effective vaccines is an educated guess that doesn’t always pan out. Further downstream, inherent skepticism among a large minority doesn’t help. Last year, almost 40% of adults (including 19% over 60) said they wouldn’t get a flu shot. Perceived side effects and lack of efficacy were major reasons cited.

    Now, on top of these challenges, consumers are looking for answers to a host of new and sometimes complex questions. Answers that require an added measure of reassurance and explanation. Even the 60% who typically welcome vaccinations might not be a shoo-in this flu season. A flexible and adaptive approach to communications and education may be needed to persuade healthcare consumers.

    This year a premium should be placed on personalized education. Consider avoiding or modifying purely prescriptive communication that could fail to capture unique concerns. A more discursive, interactive type may better address confusion and misconception, guiding customers to pragmatic resolutions that leave them pacified, satisfied and prepared.

    What is one of the first concerns a provider might need to address (whether verbalized or not)? “Can I trust your advice?” This may sound odd at first glance, but it shouldn’t be dismissed when developing a flu engagement strategy. In the wake of COVID-19, it’s been widely reported that trust in healthcare has been damaged. This is already leaving its mark. Overall vaccination rates declined nationwide during the pandemic’s first wave.

    Anticipating another top-of-mind question (Do I have flu or COVID-19?), CVS Chief Executive Larry Merlo recently told Reuters, a news agency, that “If we can eliminate…people getting flu symptoms [by giving them flu shots] and [thereby prevent] their first reaction being ‘Is this the seasonal flu or is this COVID,’ it can take demand off of COVID-19 testing.” In addition to helping providers manage capacity by persuading customers to get inoculated against flu, this limits scope for “flu versus COVID” confusion. Especially among those most vulnerable to catching both viruses such as the elderly, immunocompromised, and those with respiratory conditions.

    To complicate matters for all—consumers and providers alike—we’re expecting this flu season to be more aggressive than usual.  Manufacturers are ready to boost vaccine production by 20% above norms. For healthcare systems to avoid being overwhelmed, supply is not the only prerequisite. A premium should be placed on education to activate preventive-care behaviors and timely action by customers, such as persuading them to get a flu vaccination. Even giving a willing customer a flu shot, however, has potential complications this year. If they have symptoms like a temperature for example, their flu shot might need to be delayed pending COVID-19 evaluation. Be ready to answer: “Why can’t I get a flu shot if I have a temperature?—It’s never been an issue before.”

    Also be prepared to address issues like “Do COVID precautions help with flu?” Evidence from the Centers for Disease Control and Prevention (CDC) suggests that social distancing can help prevent flu transmission. Reinforcing this and other preventive behaviors could slow its spread. To gain compliance, however, you may need to counter “COVID fatigue.” This emerging state of mind expresses the sense that “enough’s enough.” It reflects an overwhelming need for some to return to normal life, and in the process dismiss health risks—perhaps flu among them. This mindset might be one reason COVID-19 has surged again recently, and why August 12th saw nearly 1,500 COVID-19 deaths—the most in a single day for three months.

    Many other qualms and questions add to this flu season’s unique challenges. Some reflect the potential impact of a flu-COVID double whammy wave.  Considerations include whether infection with one makes getting the other more or less likely, or if they are more or less damaging if caught concurrently. And, whether you can have a natural immunity to flu or COVID-19 (from T Cells for example). Or even if the bad flu season predicted could edge out or tamp down COVID-19 (a phenomenon called viral interference). Whatever the question, be prepared with engagement strategies that offer the right answers, and route care accordingly.

    The takeaway? During any flu season—this more than others—tailored education and agile communication is important. These can help customers make sense of a complex healthcare landscape and decide if they need to seek care. Good luck!

    mPulse is pleased to help. Details of our Flu Engagement Solution may be found here.

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    mPulse Engages 11 million Americans and Counting with COVID-19 Related Healthcare Communications

    mPulse Engages 11 million Americans and Counting with COVID-19 Related Healthcare Communications

    mPulse Mobile has collaborated with more than 20 healthcare organizations to support communication to patients and members about COVID-19. Since the pandemic was announced by WHO on March 11th, mPulse has sent out 22 million COVID-19 messages across SMS, email, IVR and mobileweb.

    To enable rapid roll-out of important communications, mPulse partnered with leading healthcare organizations, including some of the largest plans and IDNs in the country, to develop a COVID-19 Strategic Communications Tool Kit that helps solve the evolving communication and engagement requirements of the COVID-19 pandemic. The tool kit features a suite of configurable programs focused on educating members about the ever-changing situation and informing them about care access, with some programs available to launch as quick as two days.

    “The COVID-19 pandemic has crystalized the importance of mobile channels for healthcare organizations to communicate with their members and patients. We have seen rapidly evolving needs over the first 3 weeks of the pandemic, from education on infection prevention measures to raising awareness of telehealth and mail order pharmacy and the importance of using conversational AI to automatically respond to member requests to provide relief to call centers,” said Chris Nicholson, CEO of mPulse Mobile. “With mobile communications, new programs can be switched on in a matter of days, even hours. This allows our partners to keep their populations informed with the most current, vital, and actionable information.”

    The mPulse COVID-19 Tool Kit includes programs designed to communicate with a broad range of demographics and multicultural populations, supporting dozens of languages. As the pandemic continues to present unexpected challenges, new programs and capabilities are added to the tool kit to address each challenge, build health literacy and change behavior.

    “We are anticipating and responding to the psychosocial impacts of the pandemic with new programs to support those needs and to build resilience in the midst of deep uncertainty,” said Rena Brar Prayaga, Director of Behavioral Data Science at mPulse Mobile. “As social distancing and staying at home pose physical and mental health challenges, we are rolling out new programs to provide support to members. We are also paying close attention to the impact of social isolation on those who live alone, particularly seniors, and providing messaging to mitigate loneliness and anxiety during this time with tips and strategies to remain emotionally connected to friends and loved ones.”

    The COVID-19 Strategic Communications tool kit is a snapshot of the mPulse omni-channel communication solutions that support nearly 100 healthcare organizations. As the COVID-19 pandemic continually evolves, the tool kit is designed to launch quickly and adapt over time.

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