For Medicare Advantage plans, offering plan members the opportunity to create Advance Care Planning (ACP) documents intuitively just seems like the right thing to do. From the member perspective, it ensures that their care preferences are known should they become seriously ill and unable to express their wishes. But beyond being beneficial to patient care, there are a number of critical business impacts that make offering ACP particularly attractive to a Medicare Advantage (MA) plan.
Offering its members Advance Care Planning documents has the potential to positively impact a plans’ CMS Star Ratings as these documents not only meet increasing regulatory requirements but have been shown to reduce unwanted medical care when people are seriously ill or facing end-of-life decisions. Further, ACP may indirectly increase CMS Star Ratings by improving patient outcomes and satisfaction, enhancing customer experience and boosting the quality of provider-patient interactions, all of which are integral to these ratings. The significance of this cannot be understated as plans with superior Star Ratings are rewarded with higher reimbursement and bonuses, while those that underperform receive smaller CMS payments and are restricted from marketing during the special enrollment period, limiting the ability to increase the member numbers during the standard open enrollment period.
Specifically there are a few new measures CMS included in its 2023 Star Ratings where ACP has the potential to help influence a health plans’ overall Star Ratings quality performance and strategy. These include:
· Plan All-Cause Readmissions (Part C) – This measure was put on display, tracked but not incorporated into the overall Star Ratings, from 2020-2022 due to COVID but is being reintroduced as an active measure for 2023 Star Ratings. Studies indicate that ACP can reduce hospital readmissions, a key factor in Star Ratings, thereby potentially enhancing a plan’s performance.
· Follow-Up after Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (Part C) Measure – The integration of ACP into emergency department discharge protocols offers a strategic opportunity to enhance the CMS Star Ratings by reducing avoidable hospital admissions for patients with multiple high-risk chronic conditions. By ensuring rapid primary care follow-up and incorporating ACP, health systems can effectively manage chronic diseases, honor patient preferences, and reduce acute care utilization. This approach not only aligns with the measure, but also fosters long-term patient engagement in primary care, potentially driving down healthcare costs while improving care quality and patient satisfaction—a win-win for Medicare Advantage plans focused on achieving superior Star Ratings.
· Transitions of Care (Part C) Measure – In the context of the Transitions of Care (Part C) measure introduced in the CMS 2023 Star Ratings, the potential role of ACP in enhancing care coordination is crucial, particularly for patients with chronic conditions. Drawing on insights from the article “Advance care planning in older hospitalized patients following an emergency admission: A mixed methods study” the significance of physician-led ACP becomes apparent.[i] A patient from the study encapsulates this sentiment, stating, “I’d rather have a doctor explain to me what the situation was, and I’d go along with them, you know what I mean?” This reflects a preference for healthcare professionals guiding ACP, especially during significant transitions such as hospital admissions. Emphasizing a patient-centered approach, the study suggests that such provider-led ACP discussions, which account for individual patient preferences and extend to discharge planning, could potentially enhance the effectiveness of the Transitions of Care measure, thereby improving care quality for those with chronic conditions.
With the significant impact that Star Ratings can have on Medicare Advantage plans’ revenue, bonuses, and flexibility in enrollment, it is essential to recognize the value and importance of ACP. Increasingly around the country we are seeing smart CEOs view ACP as more than a mere requirement that must be met for VBID plan participation and other innovative programs. They know it is a critical element in their enterprises’ success that must be embraced and integrated into their plan’s business strategy.
ACP aligns with the principles of value-based care, offering a strategic opportunity for Medicare Advantage plans to improve member engagement and satisfaction—measures also reflected in Star Ratings. This aligns ACP with what is one of the most critical concepts of value-based care: placing what the individual values at the center of diagnostic and treatment plans. And that is just the right thing to do.
Charles Miles
Charles Miles, MPP is Chief Technology Officer at TFAAnalytics, LLC, a value- based enablement platform that helps health plans and providers deliver high-quality care to people with complex and serious health conditions. Charles brings this task a strong background in data integration, analysis, and the strategic application of BI technology to solve complex healthcare challenges. At TFA Analytics, he continues to drive technology-driven solutions that optimize care delivery, improve patient outcomes and enhance market performance for payors and providers alike. His work is helping redefine healthcare delivery for some of the most vulnerable populations and remove barriers between cost and care, demonstrating a commitment to both innovation and compassion in healthcare.
Debbie Ahl
Debbie Ahl currently serves as senior advisor at MyDirectives, the world’s leading digital advance care planning platform for healthcare providers, payers and consumers. Debbie brings to her role an extensive background in the public, private and not-for-profit sectors including more than two decades in the C-Suite and 10 years as a successful CEO at healthcare and health insurance organizations. A discerning leader with strong talent for connecting people, information and organizations, Debbie has been instrumental in the growth of MyDirectives which today offers the best tools to create, upload, store, find, download, or share ACP documents and portable medical order forms whenever, and wherever needed (mydirectives.com).
