How Tech Can Improve Health Plan Performance & Star Ratings

Paula LeClair, US General Manager of Healthy.io

The open-enrollment period that recently concluded for U.S. health plans was the first since the expiration of pandemic-linked changes to how Star Ratings were calculated. This is a period of major transition for the industry, with some health plans struggling to maintain their previous ratings and plan participants, who are now accustomed to home-based testing and treatment, expecting those services and features to continue. Fortunately, new technology can help health plans boost plan performance while promoting better care and early detection of chronic illnesses.  

The Star Rating system, which measures the quality of care and member satisfaction in privately managed Medicare plans, helps consumers compare the benefits and costs of different plans. It also impacts government payment rates.  

During the COVID-19 pandemic, temporary changes to the rating system were implemented to help support health plan performance because of the unique challenges around delivering care and collecting information. For example, plans were allowed to take the “better of” Star Ratings between 2021 and 2022 for many measures.  

Now that the pandemic relief measures are no longer in place, health plans are looking for ways to improve their Star Ratings. They should lean on new technology to do so.  

Creating and utilizing clinical-grade digital health innovations increases adherence and provides members with more accessibility. By utilizing things consumers already have – such as smartphones and videoconferencing platforms – these innovations can create new pathways to care.  

One specific example of how technology can help increase health plan performance relates to kidney health.  

In 2020, the National Kidney Foundation and the National Committee for Quality Assurance developed a new measure for kidney health called the Kidney Health Evaluation for Patients with Diabetes, also known as KED. To provide a more complete picture of a person’s kidney health, KED tracks how many adults with diabetes receive an estimated glomerular filtration rate (eGFR) and a urine albumin-creatinine ratio (uACR). The eGFR test assesses kidney function, while the ACR checks kidney damage levels.   

In December, the Centers for Medicare and Medicaid Services issued a proposal to include KED as a Star Rating. While this is great news, since only 49% of the impacted population conducts annual ACR testing, health plans will need to massively increase the number of ACR tests conducted to achieve the same success as they did under the previous measure, Medical Attention to Nephropathy (85%), which is being retired.    
  

To meet and exceed the 85% adherence rate under the new measure, health plans will need to rethink how they engage with their members. Simply making marginal improvements to the urine-testing experience within the lab will not work.  

Nor will it be enough to rely on provider incentives to boost ACR test rates. One study from 2019 showed that a comprehensive, nearly two yearlong educational and financial incentivization plan increased ACR test adherence rates from 31.3% to 33% – a two-percentage point gain.       

  

Health plans that adopt new technology that reduces barriers to testing will have a leg up. Take, for example, the smartphone camera-based ACR test recently cleared by the FDA – Minuteful Kidney™. Members can use the Minuteful Kidney kit and app to take a urine test at home and get a clinical-grade result in minutes. In trials, the Minuteful Kidney test enabled health plans to increase ACR testing adherence by up to 50% among untested populations.   

This is just one example of an emerging trend in the industry. Several companies offer apps that enable patients to use their smartphones to view their glucose levels in real-time, track their glucose history, and utilize alarms to notify them of serious medical issues like hypoglycemia.    

Technology like this can help patients avoid complications like chronic kidney disease, while also helping health plans address issues around health equity. By allowing testing and medical monitoring at the pace of each individual’s life, providing clinical-grade tests at home can break three of the key barriers to care for underserved communities: time, transportation, and low awareness—on the part of both patients and their clinicians.  

This can be a lifesaver for communities of color. Black Americans, for instance, are almost four times as likely as their white counterparts to develop kidney failure.   

It’s clear that health plans should leverage technology as they look to improve their Star Ratings. Outside of performance on any ratings system, technology can also lower costs across the healthcare system, while improving patient outcomes. It’s a win for health plans, healthcare providers, and patients alike.  


About Paula LeClair

Paula LeClair is the US GM of Healthy.io, the global leader providing platforms and services that transform the smartphone camera into a medical device.  Paula LeClair has over 20 years’ experience in healthcare. Most recently she was Executive Director and General Manager of Outpatient at Glytec. Previously she was Head of Operations at Onduo and President and CEO of Telecare, where she directed the company’s successful acquisition by BioTelemetry. Paula has an MBA from Bentley University and an MA in Healthcare Delivery Science from Dartmouth College.