How health plan quality leaders are preparing for 2023

Health plans have faced several ratings challenges this year, from growing pressure to improve member experience to increased scrutiny around access measures.

Consequently, having strong analytics is even more critical now that CMS has doubled the weighting of CAHPS member experience and access measures for 2023 stars awarded in October 2022.

And with many changes still ahead, health plans should be preparing today for their 2023 CAHPS surveys by employing a strategic, data-driven approach to performance improvement.

In 2022, some trends remain the same, like needing to perform exceptionally well in member experience and access metrics to compete for increasingly limited monetary bonuses. To do this effectively, health plans will need credible data that reveals member-level trends based off CAHPS, HEDIS, and other quality measurement tools.

But we’re starting to see new trends emerge too, such as health equity's close ties to incentives as well as commercial success.

For example, NCQA published an Issue Brief focused on key considerations in using HEDIS to assess and advance health equity. And, in a February press release highlighting proposed payment policy changes for Medicare Advantage, CMS noted that this year the agency “is specifically soliciting input through a health equity lens on the approach to some future potential changes.”

In the near future, plans will be held even more accountable for demonstrating member experience improvements for vulnerable and higher-risk members. Health plans will need to obtain quality data from multiple sources to successfully address this area.

With these impending shifts in mind, here are three actions health plans can leverage in 2022 to elevate 2023 performance:

1. Take a more comprehensive analytics approach.

Analytics is no longer a myopic, one-dimensional process or concept.

A deep dive, or descriptive analytics, can immediately identify positive and negative trends within certain member cohorts. Meanwhile, predictive analytics provides added value by forecasting future performance—such as likely behaviors and perceptions of healthcare—by members.

When used together, health plans have a holistic view of the member experience and can prioritize the right initiatives at the right time for the greatest impact.

2. Dig deeper into root cause analysis.

Member data derived from internal processes doesn’t always tell the full story of population health.

Working with a third-party expert to analyze multiple data sets, along with benchmarking reports, registries, and historical health data, can give health plans a more vivid, detailed picture—and help them identify more tangible opportunities for improvement.

3. Combine disparate data sources to generate actionable, predictive models.

To accurately anticipate future member perceptions and behaviors—such as likelihood to respond to a CAHPS survey, likelihood to be highly satisfied, or likelihood to re-enroll—you have to integrate data from multiple sources and run it through a predictive model.

Key data sets to focus on include:

• What happened to the member: claims, utilization, out-of-pocket costs, or customer service call logs
• How engaged the member is with their PCP: visit history and compliance with preventive care
• Member perceptions: surveying and benchmarking data
• Member economic and social conditions: social determinants of health and census data

The output of the predictive model then becomes a “member engagement blueprint” that leaders should utilize to create impactful, targeted outreach campaigns to inform, encourage, engage, and educate members. Bottom line: The more health plans leverage data-driven decisions now, the better prepared they’ll be for upcoming 2023 and 2024 star rating changes.

Learn more about how Press Ganey works directly with health plans to address these new challenges and opportunities.

Mike Foytik is the Chief Analytics Officer of SPH Analytics, a Press Ganey Solution, and David Larsen is a Senior Advisor, Payer Solutions, at Press Ganey.