The CX prescription: 5 steps to higher CMS star ratings in healthcare

In the competitive world of Centers for Medicare and Medicaid (CMS) star ratings, every point counts. These ratings significantly impact healthcare organizations, influencing not only funding but also patient acquisition and overall market position.

Approximately 74% of Medicare Advantage Prescription Drug (MA-PD) plan enrollees are in contracts with 4 or more stars, leaving plans with lower ratings to compete for just 26% of the market share.

In 2024, things got even more challenging with new measures, like Plan All-Cause Readmissions, being incorporated into the star rating formula, which places even more focus on care coordination and outcomes. To stay ahead, healthcare organizations need to strike the right balance between improving patient satisfaction and meeting clinical performance targets.

The key? Leverage real-time data, focus on patient-centered strategies, and work with experts to optimize care. That’s how you improve both ratings and outcomes, ensuring that patient experience and clinical results are in harmony

5 steps to higher CMS star ratings in healthcare

Achieving higher CMS star ratings requires more than just meeting benchmarks — it’s about creating a seamless, patient-centered experience. These are my five strategies to help your organization navigate new CMS measures, improve patient satisfaction, and maximize reimbursement.

1. Leverage data accessibility and actionable analytics

Real-time data is a critical tool for improving CMS star ratings. Using advanced analytics platforms, organizations can identify performance gaps and act quickly to address them.

For example, compliance with key metrics like seven-day follow-ups for high-risk members can be monitored and improved through telehealth tools and analytics dashboards. These tools allow care teams to prioritize patient needs and ensure timely interventions that boost both satisfaction and outcomes.

Voice of the Customer programs provide an additional edge, collecting real-time patient feedback to pinpoint areas for immediate improvement. Studies show that organizations leveraging patient feedback not only improve their CMS star ratings but also see higher retention rates among members.

2. Enhance agent and patient experience with integrated technology

In the pursuit of better patient outcomes and satisfaction, healthcare organizations can benefit from integrating technology to streamline workflows and improve communication. 

A prime example comes from an extensive health system that unified its customer and agent experiences using CRM. This transformation integrated multiple touchpoints under a single interface, improving operational efficiency and patient engagement.

Key outcomes included:

• 60-90 seconds saved on appointment scheduling via automation
• 20-45 seconds saved in post-call notetaking thanks to AI-powered summarization tools
• Improved patient satisfaction (CSAT) with a 360-degree view for better personalization

This patient-led approach resulted in projected net benefits of $18.7 million over five years, delivering a 349% ROI while boosting patient satisfaction and contributing to higher CMS ratings.

3. Improve patient experience with a focus on key measures

Patient satisfaction is a cornerstone of care. Improving these scores requires seamless, personalized interactions that put patients first. 

A digital front door strategy can simplify how patients engage with care providers, incorporating tools like online appointment scheduling, secure messaging with care teams, and transparent communication about next steps in care plans. These tools not only reduce no-show rates but also ensure patients feel informed and involved in their care, leading to higher satisfaction and better outcomes.

For example, online scheduling platforms make it easier for patients to manage appointments, while secure messaging allows them to communicate directly with their care teams. By providing access to personalized care plans and automated reminders, healthcare organizations help patients stay on track, ultimately improving both patient experience and CMS ratings.

4. Address new CMS measures with proactive strategies

New measures introduced in 2024 — like Follow-Up for High-Risk Chronic Members — demand innovative solutions. Advanced technologies such as AI and automation are critical to meeting these requirements.

For example, AI-powered segmentation can identify high-risk patients, enabling teams to prioritize interventions that prevent readmissions. Omnichannel engagement platforms help deliver automated follow-up reminders, ensuring compliance with CMS follow-up metrics. 

Secure communication tools also enable seamless collaboration among care teams, improving care transitions and outcomes. Organizations adopting these technologies have seen reductions in readmission rates and measurable gains in CMS metrics.

5: Partner with experts to maximize efficiency

Finally, partnering with experts like TTEC Digital can accelerate improvement efforts. By leveraging specialized knowledge in patient experience, data analytics, and technology, healthcare systems can benefit from optimized solutions in areas you may not even be thinking about.

For example, one provider worked with TTEC Digital to enhance their interactive voice response (IVR) system. Our recommendations, such as targeted routing, a menu redesign and self-service messaging, led to:

• 40% reduction in call volume
• $746K in annual savings

This collaboration helped the organization optimize its resources, handling a larger volume of contacts without the need for increased headcount. Most importantly, by redirecting them to self-service options, patients had lower wait times, received quicker access to care and experienced more efficient service, improving their overall satisfaction.

Aim for the stars with your patient experience

When you focus on real-time data, patient engagement, and new CMS measures, improving CMS star ratings becomes a much more achievable goal. 

With a commitment to enhancing the patient experience, organizations can boost ratings, leading to better reimbursement and a stronger market position.