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Prepping Now for 2022 CMS Star Ratings: How Health Plans Can Embrace Preventative Care That Reduces Senior Falls

Each year, the Centers for Medicare and Medicaid Services (CMS) releases the Medicare Advantage and Part D star ratings which measure the performance of a health plan and prescription drug plans. These ratings empower Medicare beneficiaries to compare plans on more than just cost, but also quality and satisfaction. However, sustaining high ratings is becoming increasingly competitive – it’s no longer enough to maintain quality, but rather, constant improvement in available offerings to meet consumers’ changing health needs becomes a must to reach the four- or five-star mark.

Connecting high ratings with improved patient outcomes

CMS rates health plans on more than 40 quality measures in the following five categories: staying healthy, managing chronic conditions, member satisfaction (including access to care), member complaints and customer service. The “staying healthy” measure involves preventative care such as screenings, testing and vaccinations.

The first step in the delivery of preventative care is identifying those members at risk of developing or have been diagnosed with chronic conditions and providing member outreach to increase their awareness of available resources. This includes educating members about the importance of obtaining annual vision exams which is often the first step in identifying health risks and thereby resulting in early and cost-effective interventions.

According to the CDC, Americans 40 years of age or older are at greater risk of eye diseases and injuries due to falls. By proactively screening members 40 years of age and older, who have a greater risk for deteriorating vision and eye disease, health plans can get ahead of preventable and potentially costly injuries, thereby preserving members’ health, care costs and quality of life.

Maintaining member safety with proactive vision care

Degenerative vision problems—which can be associated with underlying health conditions—are associated with increased risks of falls and injuries. Unfortunately, falls are more common than one would think – one in four Americans aged 65+ fall each year. Most falls are caused by a combination of risk factors that can be properly managed, including vision problems, lower body weakness and difficulties with walking, all of which can contribute to permanent injury, high economic costs, and in some cases, death.

Empowering members, especially older adults, to seek routine eye exams can serve as a vehicle for prevention by lowering the risk of vision loss, as well as identifying symptoms associated with multiple chronic conditions. For example, diabetic retinopathy, a condition caused by diabetes that weakens the blood vessels in the retina, can trigger falls by causing cloudy, blurred and even loss of vision. More than 25% of Americans age 65+ have diabetes, which increases the risk of diabetes-related blindness. By understanding the relationship between chronic conditions and the susceptibility of falls, health plans can serve as proactive participants, enabling members to remain healthy and safe by lowering their risk of falls due to compromised vision.  This type of proactive participation resulting in increased member satisfaction and healthier outcomes will have a positive effect on star ratings, member retention and the ability to attract new Medicare Advantage members.

To learn more about the relationship between vision and senior falls, check out our whitepaper on this topic here.

References and White papers/Seniors and Falls CAM-567_P2.pdf

© 2021 Versant Health Holdco.

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