Originally published by Evolve
Star ratings are essential to the growth, success, and notoriety of Medicare Advantage plans. Awarded by The Centers for Medicare & Medicaid Services (CMS), these ratings are based on various performance metrics, including quality of care, customer service, and member experience. They are also one of the most effective ways to differentiate a plan because they verify that the organization provides high-quality care.
Because of the recent decline in the star ratings published by CMS, it is critical for Medicare Advantage plans to achieve high star ratings. To do this, they must focus on strategies that help increase member safety, engagement and satisfaction, improve outcomes and quality of life, and support better care management.
Fortunately, there are creative solutions available today! Home and community based services, like Clinical In-Home Assessments, Home Modifications, Vehicle Modifications, and Assistive Technology can play an essential role in helping plans boost their star ratings.
Several Part C measures, including “Reducing the Risk of Falling”, “Transitions of Care”, and “Care Coordination” can be positively impacted by addressing the needs of the member’s home. Implemented actions to improve these measures will ultimately allow the members to remain in their community and the place member’s prefer to be, as well as influence star ratings.
How Can Home Modifications Help Medicare Advantage Plans Improve Star Ratings?
Closing Care Gaps
From Social Determinants of Health (SDoH) to Community Supports, home modifications help close care gaps by addressing members’ accessibility needs within their home and empower better outcomes of the member’s activities of daily living. When a member isn’t afraid of falling, they feel more comfortable and may have greater tolerance to medication adherence, physical therapy compliance, and are simply happier.
Enhancing Member Satisfaction and Engagement
Member satisfaction is a key component of star ratings. Approving a member for a home modification seems easy, but how to operationalize it and knowing the member is satisfied with the completed service is another. Healthcare and construction don’t always understand each other or see eye-to-eye. Evolve’s process starts with a clinical in-home assessment done by a physical therapist or occupational therapist and concludes with a comprehensive completion process that brings it all full-circle. It starts and ends with member involvement, while giving all parties involved the opportunity to give feedback on the service and the process. This closes the gap on member satisfaction so everyone is heard and engaged!
Ensuring Member Safety, Health and Quality of Life
When we allow a member to remain in their home, we are giving them a chance to live the life they want to live. Far too often when we see our loved ones or members age, we want to help and think that by making decisions for them, we are helping. Most members are capable of thinking and doing for themselves, they just need a safe way and safe environment to do it in. Doing a home modification or installing devices for assistive technology can greatly improve the members’ quality of life because they are able to think and do what they want, by themselves. Members then have independence and that independence will improve their health.
Reducing Hospitalizations and Care Costs
An important factor impacting star ratings is the frequency of hospital admissions and readmissions. Giving the member a safe home can be instrumental in reducing these occurrences by offering grab bars, wheelchair ramps, personal emergency response systems (PERS), pest control and stair lifts. This helps health plans reduce unnecessary ED visits and hospitalizations, ultimately lowering care costs. According to research done by Eriksen and Engelhardt, home modifications reduce the incidence of falls by 50 percentage points for those ages 75 and older. Every $1 invested in modifications returns $1.50 in reduced medical spending for people ages 75 and older.
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