Achieving five-star success: takeaways from the Medicare Star Ratings & Quality Assurance Summit

Last week, I attended the Medicare Star Ratings & Quality Assurance Summit in Miami, Florida, where more than 100 attendees met to discuss Medicare Advantage Star Ratings, sharing case studies and best practices on how to achieve the coveted five-star rating. With numerous presentations from a wide variety of health plans who shared their opinions and recommended courses of action, three overall trends stood out.

Member engagement drives improvement 

The conference started with a discussion on why member engagement is critical, a theme that continued throughout the day. Several plans spoke to the importance of CAHPS® surveys and conducting off-season surveys to improve their member relations—you might recall that CAHPS measures are increasing to a weight of two in 2019. Other plans spoke on how they are reducing member abrasion by consolidating their outreach efforts.

Health plans have a tough hill to climb in this area. They need to work across departments to ensure the right communication is going out to members in their preferred channel, and often enough to encourage behavioral change without annoying their members. Health plans that have accomplished this have seen great rewards. The market continues to become increasingly competitive with new plans appearing each year, so member engagement could be one area in which your plan can outshine the competition.

A team approach overcomes limited resources

Each health plan that presented during the conference mentioned that it only has a small team to run its Star Ratings program. Although Star Ratings are critical to health plans, most plans only allocate a small number of resources to track and trend the measures. To achieve four stars or more, this constraint makes it critical for internal teams to take a multi-disciplinary approach and meet frequently to review measures, barriers, and problems while highlighting areas of opportunity.

With a small team, it can be tough and overwhelming to start too many interventions at one time, but by using resources across departments, health plans can alleviate this pressure to ensure that all areas of the Star Ratings program are being monitored for optimal performance. It was clear at the conference that successful plans have implemented this team approach, creating strong partnerships not only within their organization, but with providers and vendors as well.

Measuring past success is the key to future success 

Measure ratings won’t improve if no one is reviewing them and validating the results. If you received five stars in one measure, but never reviewed it to understand how you got there, the odds of staying at five stars are very low. Every measure is important, and your team needs to work together to make sure you understand exactly what is being measured and how you can sustain or achieve five stars.

For example, you may be receiving five stars in the appeal measures, thus boosting your overall contract rating. That rating could be at risk, however, due to the unfortunate impact of the new Timeliness Monitoring Project, as noted by several presenters. These plans emphasized how they had to quickly review the measures and work together to correct issues before the second preview was published. By understanding each measure up front and educating team members across departments, such as customer service, pharmacy, and appeals, plans can avoid the scramble at the end and ensure they are receiving their expected rating and associated rewards.


Star Navigator is a quality improvement solution that helps Medicare Advantage plans determine the most direct path to higher Star Ratings, then track and communicate their progress toward goals. Learn more from our fact sheet.


Read the fact sheet


CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).


Ashley McNairy
Ashley McNairy is an experienced senior product director supporting Cotiviti's Risk Adjustment, Quality and Stars, and Consumer Engagement solutions. Her primary responsibility is the successful delivery of our solutions, ensuring they address the most pressing challenges for HEDIS, Star Ratings, member engagement, and retrieval initiatives. Driven by her passion to see improvements in healthcare quality, Ashley takes pride in working with clients to improve their quality initiatives and enable better care for their members.

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