Back in July, we briefly mentioned the changes to the breakdown of CMS Star Ratings and, most notably, the increased importance of member experience. Let’s dig into the full scope of how CAHPS scores will affect overall Star Ratings in 2023, why member experience matters, and measures that can be taken to improve it.




CMS Star Ratings help patients enrolled in Medicare determine which plan is best for them based on a scale of 1 to 5 stars. Patients typically choose plans that are in the 4 or 5-star category:


“Approximately 72% of people currently in Medicare Advantage plans that offer prescription drug coverage are enrolled in a plan that earned four or more stars in 2023.”


Year after year, it’s been demonstrated that the plans with less than 4 stars are not faring well. In fact, CMS reports that 90% of all health plan memberships are for plans that have a star rating of 4 or above, which is up 13% from a year ago.


Let’s explore what to explore in the calendar year 2023 in order to determine how to achieve a 4 or 5 Star Rating.




In 2022, CAHPS scores comprised 23% of the Star Ratings. In 2023 it will be 33%. That is a 43% year-over-year increase. With such a significant jump, it’s imperative for payers and providers to pay attention to the customer experience in order to maintain or increase their Star Ratings for 2023 and beyond.


Since achieving a 5-star rating in 2023 will weigh heavily on member experience, surveying will be especially critical. “Phone calls and home visits are both hard and expensive to perform, but there is no path to a 4+ Star Rating without strong CAHPS scores.”


The attention paid to member experience will have a direct impact on the success or failure of payers and providers.





  1. It affects the bottom line.


Improving member experience will increase CAHPS scores. Better CAHPS scores will increase (or maintain) a good Star Rating. This, in turn, will increase the likelihood that Medicare enrollees will choose a certain plan with certain providers, thus increasing revenue.


It is worth mentioning that retaining existing customers is far more cost-effective than getting new customers. Patients can manage their health in a more cost-effective way, which hopefully means less expensive procedures that cost payers.


With technology at our fingertips and the ability to shop around for plans and providers, patients have the ability to be picky. A positive member experience matters on several levels, and it will be a determining factor when choosing a plan or provider. In fact, 59% of patients spend a lot of time researching options before choosing a healthcare provider.



  1. It has intrinsic properties.


The strength or weakness of the relationship between payers and/or providers and patients are the nuts and bolts of the member experience. Ultimately, this will improve the health care system as a whole and hopefully the health of patients as well. If they feel listened to, they will be empowered in their health journey. Personalizing a member’s experience can make them feel seen and heard and lead them to stay with a plan or provider:


“Increased engagement requires regularly taking feedback from customers and equipping healthcare staff with patient history, preferences, and metadata. This is especially important for customer-facing staff, as having employees be cognizant of their treatment history can feel reassuring.”


  1. It has a ripple effect.


When patients are empowered and informed, this has a ripple effect on the health care system as a whole and likely on their personal life as well. They will be healthier, more satisfied with their care, less confused or frustrated, and less likely to leave a plan or provider:


“58% of Millennials surveyed say responsiveness to follow-up queries via phone or email communications outside of their appointment is extremely important to their overall satisfaction with their plan or provider.”





Now that we have determined why member experience is important, let’s take some concrete steps to address it. Here are seven suggested ways to improve member experience:


  1. Retain current members.


Make sure new members are onboarded properly, and all of their initial questions are addressed as soon as they arrive. Survey members continuously in the first year they join a plan.


  1. Be inclusive.


To avoid a negative experience, members need to understand their plan, what benefits they have, and generally what they can expect. Be as inclusive as possible, this means different things. Use inclusive language with survey questioning so you can identify any potential gaps or limitations to proper care. Furthermore, telehealth should be an option for any patient that has physical limitations.


  1. Providers should be delivering quality care.


This is where the rubber meets the road. If a patient has a negative experience, this can dictate plan retention, and affect Star Ratings and the ability to recruit new patients. The ground level is where the patient can determine whether their plan is working for them and whether they are getting the answers to any questions they have.


  1. Technology is your friend.


Empower members to become a part of their health journey. Communicate how they can view their appointments, test results, and more through existing apps or software.


Integrating data between payers and providers is essential to offering the best care. If these two parties have a complete view of a member’s health history, it can only benefit everyone involved and streamline care.


  1. Address health literacy.


There are varying levels of health literacy across health plan members. Those with a lower level may have difficulty understanding details about their plan. This can lead to dissatisfaction with coverage and care. It is highly recommended to assist these members with understanding their benefits so they can use their plan to the fullest extent.


  1. Offer member incentives.


Empower individuals through financial compensation to join a gym, or offer less expensive premiums for non-smokers. Plans that have these member discounts for healthy choices will only benefit in the long term.


  1. Continuous surveying.


Beyond CAHPS surveys, payers and providers can attain a more granular idea of member experience. Brenmor’s expert surveying technology goes above and beyond and offers continuous feedback. It will pay off. Speak with an expert today.