Improving the Human Experience Through an Integrated and Data-Driven Patient/Member Experience Approach (134H)

The Centers for Medicare and Medicaid Services' (CMS) Star Rating system helps empower Medicare consumers to make healthcare decisions on the quality of health and drug plans being offered that are best for them. Providing care and coverage for patients and plan members with complex health problems and special needs becomes even more challenging. Results from UPMC Health Plan's 2022 CAHPS survey revealed significant declines in the Star rating performance from the prior year in the Care Coordination composite measure, especially among plan members in the special needs population. Similarly, on UPMC Health Services side, overall patient perception of access measures and care coordination for medical practices began seeing dips in performance in its Press Ganey survey scores. In this session, presenters will discuss the detailed data exchange strategy utilized to support the impact of collaboratives on medical group and Star ratings that help patients, health providers and plans alike and improve access, quality of care and customer loyalty.