Health quality initiatives, heightened competition and stricter CMS Star-Rating benchmarks are driving a need for more precise care solutions that yield better patient outcomes.
What strategies can help health plans implement scalable solutions that meet these rising performance expectations?
Recently, a Teladoc Health panel of experts convened to discuss the transformative impact virtual care can have on Medicare, specifically its influence on Star Ratings and driving stronger member engagement. The panel consisted of moderator Hunter Sinclair, Vice President of Solution Strategy, Glen Davis, MD, Vice President of Clinical Programs and Anne-Kathrin Eiselt, Ph.D., Applied Behavioral Science Director.
The quality initiatives in Medicare Advantage (MA) have become increasingly challenging due to heightened competition and rising cut points. This year, about 70% of cut points became more difficult, reflecting both methodological changes and significantly improved performance across the board. For example, the threshold for achieving a two-Star Rating in blood pressure control increased by 11%, making it clear that what worked last year may not necessarily work in the future. These changes, while beneficial for members who rely on improved care, present substantial hurdles for health plans striving to maintain or improve their Star Ratings.
Addressing these challenges requires innovative strategies, such as leveraging behavioral science and targeted interventions to engage members who fall short of desired outcomes. Teladoc Health is a critical partner in this effort, working with a diverse range of MA plans to deliver impactful virtual care services and chronic care programs to over 200,000 Medicare beneficiaries. As competition intensifies, plans must adapt rapidly to meet escalating standards and maintain parity with national and local competitors.
Advancements in healthcare technology are transforming how people access and engage with care, particularly for those facing behavioral and logistical barriers. By combining insights from behavioral science with AI-driven tools, Teladoc Health is empowering members to make healthier choices and achieve better outcomes.
Behavioral science and AI-personalized outreach can help overcome barriers to care. Dr. Eiselt acknowledged that making better choices isn’t always easy. She explained, “We’re not always acting in our best interest,” but using that knowledge can help overcome common barriers. When we understand what’s holding people back, we can help them make healthier choices—which is especially hard in our current environment. Strategies for overcoming behavior change challenges and increasing engagement include personalized nudges, real-time insights and accessible virtual options to promote long-term behavior change.
Connected devices can also go a long way to help. Information from cellularly connected glucometers feeds into the Teladoc Health AI engine to drive digital and human coaching. This is just one of the many ways Teladoc Health supports members, especially members with limited digital literacy.
In reviewing the positive effects virtual care can have on quality performance metrics, Dr. Davis explained that plans leveraging the Teladoc Health chronic condition management programs outperformed the national average across several health plan Star Rating categories by +0.5 to +1 with notable strengths in diabetes control—exceeding the national average by more than one point. Similarly, Teladoc Health client partners outperform others across six measures including diabetes eye exams and controlling high blood pressure.
Additionally, Dr. Davis shared client success stories resulting in:
Virtual care and behavioral science principles allow health plans to offer more personalized and accessible pathways to overcome common barriers to care, help health plans increase engagement among older Americans and positively impact Star Ratings. By leveraging these pathways, health plans can create more effective and patient-centered care models. And, what’s good for their members is good for the health plan in terms of achieving five-Star level performance.
Watch the full webinar recap to learn more.
