As the leaves turn colors and the aroma of pumpkin spice lattes fills the air, it can only mean one thing—Open Enrollment season is upon us. This magical time of year is when partnerships thrive, connections are forged, and lucrative business opportunities abound in the health insurance industry.
The Open Enrollment Period presents an opportunity for health plans to attract new members and retain existing ones. One powerful tool that can make a significant difference during this period is health plan ratings. In this article, we’ll cozy up to the importance of health plan ratings during Open Enrollment, how they can influence business growth, and what you can do to increase them.
Open Enrollment Period for Health Insurance Coverage in 2024
Before diving into health plan ratings, let’s take a quick look at the various Open Enrollment Periods for health insurance coverage in 2024.
Individual Health Insurance Marketplace Open Enrollment
Federal Marketplace Open Enrollment Period: November 1, 2023, through January 15, 2024
The annual Open Enrollment Period is a timeframe in which consumers can compare, sign up for, or change their individual or family health insurance plans through the Marketplace on healthcare.gov. It is available for individuals without health coverage through work, Medicare, Medicaid, CHIP, an employer-sponsored plan, their parents’ plan, Veterans Affairs, or other qualifying sources.
State-based Marketplace Open Enrollment Period
States with their own exchanges have the flexibility to establish their own open enrollment schedules, provided that the final deadline is not earlier than December 15. Although many states follow the same November 1-January 15 schedule that Heathcare.gov uses, a few variations exist. For the official enrollment schedule, visit the respective state-run exchange website.
Medicare Annual Enrollment Period
Medicare Annual Enrollment Period: October 15, 2023, through December 7, 2023
Medicare Annual Enrollment Period (AEP), also known as the Medicare Annual Election Period and the Medicare Open Enrollment Period, is a timeframe in which consumers with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs. All plan and benefit changes go into effect on January 1, 2024.
Medicare Advantage Open Enrollment Period
Medicare Advantage Open Enrollment Period: January 1, 2024, through March 31, 2024
The Medicare Advantage Open Enrollment Period is a time in which individuals currently enrolled in a Medicare Advantage Plan can switch to a different Medicare Advantage plan, return to Original Medicare, or add a standalone Part D plan. Coverage starts on the first day of the month after an application to join a plan is accepted.
Why Health Plan Ratings Matter During the Open Enrollment Periods
During Open Enrollment, consumers shop for the health insurance plan that fulfills their needs, including high-quality care, reasonable costs, and trustworthy customer experiences. With a multitude of choices available, consumers naturally look for guidance to make well-informed decisions. This is where health plan ratings come into play.
Health plan ratings and Star Ratings act as reliable guideposts to help individuals understand the quality and performance of different health plans. These ratings consider factors such as customer satisfaction, medical care and outcomes, provider networks, and affordability. In essence, they serve as a trusted friend who has already conducted research and shared the information.
NCQA Health Plan Ratings
The National Committee for Quality Assurance (NCQA) releases Health Plan Ratings for commercial, Medicare, Medicaid, and Exchange health plans every year. These ratings are provided as a report card, offering insights into how well your health plan performs. Ratings are given on a scale of one to five stars. NCQA evaluates health plans based on their HEDIS® and CAHPS® scores, and their NCQA Accreditation status as of June 30, 2023.
Find Your 2023 NCQA Health Plan Ratings: The ratings for this year were released on September 15, 2023. If you’re curious about how your health plan scored and want to dive into the finer details, visit NCQA’s website.
Medicare Advantage and Part D Star Ratings
Medicare Advantage and Part D Star Ratings, developed by the Centers for Medicare & Medicaid Services (CMS), are widely recognized metrics used to assess the quality of these plans. Ranging from 1 to 5 stars, these ratings consider factors such as quality of care, member experience, and customer service. Consumers rely on these ratings when selecting a healthcare provider, making them crucial for health plans aiming to attract customers.
Find Your 2024 Medicare Advantage and Part D Star Ratings: CMS released the Star Ratings on October 13, 2023. To see how your health plan scored and explore the details, visit CMS’s website 2024 Medicare Advantage and Part D Star Ratings and Part C and D Performance Data.
How High Plan Ratings Can Influence Business Growth
High plan ratings can work wonders for growing your customer base and improving your bottom line. Here are key ways these ratings can work in your favor.
Establish Trust and Credibility
High health plan ratings do wonders for establishing trust and credibility among existing and potential customers. They act as a seal of approval, representing consistent positive outcomes and customer satisfaction. By showcasing a high rating, you can gain consumers’ trust and differentiate your services from competitors.
Attract New Consumers and Increase Renewals
Potential customers value ratings when making health insurance decisions. By maintaining a high health plan rating, you’ll attract more consumers and increase your chances of retaining existing customers. Consumers want reliability, and a high rating demonstrates you’re a health plan they can trust.
Demonstrate High-Quality Care
Amidst fierce competition, high health plan ratings are a distinguishing feature for your business. Include them in promotional materials, social media campaigns, website pages, and advertising efforts to let people know about your exceptional care. Consumers searching for the best health insurance will be attracted to your focus on exceeding industry standards.
Achieving High Health Plan Ratings: Tips for Provider Network Management
To achieve high health plan ratings, effective provider network management is vital. To meet CMS and NCQA’s requirements for network efficiency, adequacy, and consistency you need the right tools and strategies. Here are some strategies to help you attain high health plan ratings and emerge as a top contender in the industry.
Tip 1: Automate to Actively Manage
One of the essential aspects of effective provider network management is actively managing your provider data and network. By using automation and enterprise solutions, you and other teams within your organization have access to key information for regular and seamless network analysis and refinement. This gives you the ability to know the status of your network, prevent errors, and stay on top of deficiencies consistently and continuously. Here are some data elements to actively analyze.
- Which providers are actively seeing patients
- Which providers offer telehealth services
- Which providers are listed at more than 10 locations
- Which providers have cultural and linguistic information
By having access to this data, you can elevate your health plan ratings and ensure patients have access to timely and appropriate care.
Tip 2: Impress with a Proven Compliance Program
CMS and NCQA pay close attention to your compliance programs for provider data accuracy. Having a well-structured compliance program as part of your provider network management is critical. Here are some action items to include in your program.
- Monitor, analyze, and identify areas for improvement in your network.
- Implement interventions to address any issues discovered.
- Regularly measure the effectiveness of your network and data management programs.
A proven and defensible compliance program will enable you to pass compliance audits and enhance your health plan ratings.
Tip 3: Partner with the Right Healthcare Providers
Achieving high-quality care includes finding the right healthcare providers to partner with. To identify the right match, you need easy access to additional data and insights. Here are a couple of data elements to include when analyzing potential providers.
- Top Provider Conditions and Procedures: Look for providers who specialize in areas relevant to your members’ healthcare needs.
- Provider Program Participation: Know which providers participate in the specific programs your members require.
Want to make this process even easier? Learn how Quest Enterprise Services Provider Claims Insights gives you more data in a single platform, helping you reduce the amount of time to find the providers best suited to meet your members’ needs.
Take Advantage of The Open Enrollment Season
Open Enrollment season is a fantastic opportunity to make a positive impact on your business. Embrace health plan ratings as a powerful tool to attract customers, build trust, and deliver high-quality care. With the right strategies and a focus on provider data accuracy and adequacy, you can take your health plan’s success to the next level. Best of luck and happy Open Enrollment season!
More On Provider Data Accuracy and Network Adequacy
Stay up-to-date on the latest developments and best practices in provider data accuracy with these valuable resources! We’ve rounded up some of the most helpful articles on current network adequacy and provider data accuracy rules to help you navigate the changing landscape. Dive in now!
Proven Solutions for Your Provider Network Management
Looking to simplify your workload? Let Quest Analytics take on the heavy lifting! Our solutions and dedicated team specialize in provider data accuracy and provider network adequacy for various lines of businesses, including Medicare Advantage, Medicaid and Commercial. Schedule a strategy session today and see how we can help you every step of the way.
