Challenge

Higher Star Ratings are associated with a strong reputation and increased enrollment, retention, and revenues. But the truth is MA plans often find it challenging to achieve and maintain a high rating as Star Survey scores correlate to several dynamic and demanding factors:

• Plans must demonstrate strong performance across all evaluation areas as underperformance even in one area could result in a decline in ratings.
• Agents must attain and maintain top-notch skillsets to ace CMS test calls, necessitating ongoing training and coaching.
• Technical challenges ranging from call drops and language interpreter delays to Unknown Failed Calls can significantly influence the overall score.
• Lack of proper understanding of evolving CMS requirements for Stars evaluation and inability to rapidly adapt processes to the changing requirements can significantly impede positive outcomes.
• Inability to scale trained and empathetic agent workforce at short notice can lead to poor member experience, in turn impacting ratings.

Solution

Acknowledging the formidable challenge, ResultsCX recognized the necessity for a specialized team to meet the rigorous demands and requirements for Star Ratings. Consequently, we established a dedicated CMS Taskforce that has been providing support to multiple MA plans for the past seven years. The taskforce places a high priority on comprehending the intricacies of the Star measures and consistently enhances its skills and competencies to help clients excel in all metrics for ratings improvement. The ResultsCX CMS Task Force, along with our instructional design team, has developed mandatory training for test call agents and leaders on CMS campaigns to ensure readiness.

In facilitating our clients’ journey towards a 5-star rating, the CMS task force adopts a proactive approach by focusing on the following key strategies, assisting agents in preparing for progressively challenging rating criteria.

• Comprehensive and advanced training for agents
  • Conducting mock calls, quizzes, role plays, and scenario-based training to ensure accuracy and timeliness, as assessed by CMS secret shoppers.
• Multilingual support
  • Enabling multilingual capabilities to provide optimal support to members, including a priority language line for CMS test calls.
• Agent performance analysis and coaching
  • Analyzing agent performance patterns against Star Survey measures and providing targeted training and coaching to address any identified gaps.
• Enhanced support and incentives for agents
  • Providing daily reminders on CMS preparedness, access to high-quality references, and a shared best practices repository.
  • Facilitating internal CMS chat for supervisors to swiftly assist agents as needed.
  • Conducting regular on-floor check-ins by supervisors to promptly address issues identified during CMS test calls.
  • Offering regular training refreshers for supervisors to stay abreast of updates.
  • Implementing various internal motivational initiatives and client incentives to encourage agent performance.
• Recommendations for best practices
  • Advising clients based on market intelligence, such as suggesting separate TFNs for CMS Part-C and Part-D to address potential unknowns in the future.
  • Offering different evaluation methods to clients as the ratings methodology evolves, such as the Tukey scoring methodology.
• Proactive monitoring and mitigation of issues
  • Monitoring calls for technical issues and promptly raising red flags to proactively address and mitigate any identified issues.