Rising Stars: How a Regional Health Plan Gained a Full Star by Transforming Part D Performance

At a Glance

Challenge: A regional health plan aimed to improve performance on specific Part D 5‑Star measures and enhance the overall member experience.

Solution: Developed and executed a segmentation and multi-channel outreach strategy targeting members and providers with the greatest impact on performance, using behavioral science principles to break barriers and improve engagement. Built the business case with early pilot results to secure funding for a multi-year program expansion.

Results: Overall Star ratings increased by one full star (from 3.5 to 4.5) across both contracts, driven by significant improvements in key Part D and CAHPS measures.

Client Profile

A leading regional health plan serving individuals, families, and healthcare providers, delivering comprehensive health solutions, including medical, dental, vision, and pharmacy benefits, across multiple lines of business.

Business Opportunity

Part D plays a defining role in how members choose their Medicare Advantage plan. In a 2024 Kaiser Family Foundation survey, Medicare beneficiaries reported that access to specific doctors and prescription drug coverage were key factors in their plan selection.¹

Recognizing the importance of Part D in both plan selection and satisfaction, the organization aimed to improve performance on targeted Part D 5‑Star measures while enhancing the overall member experience. The objective was to design and launch a proof of concept for an in‑house clinical program to drive measurable improvements through personalized member outreach, strategic provider partnerships, and cross‑functional collaboration to strengthen overall Star performance.

Engagys Solution

Engagys partnered with the regional plan to design and implement a comprehensive program that addressed immediate performance needs while establishing a foundation for long-term strategic planning and sustainable improvement. Solutions included:

• Segmentation & Prioritization: Developed segmentation approach to identify and target members with the greatest potential impact on performance measures.
  Behavioral Science Training: Outbound callers were trained in behavioral science techniques, equipping them to address member barriers and deliver barrier-breaking messages.
• Multi-Channel Campaign Design: Optimized and launched campaigns using phone, print, and email, with messaging designed to break down barriers to medication adherence and engagement.
• Business Case Development: Early pilot results were used to build a compelling business case to fund program expansion, leading to program approval and launch of a full-scale in-house program.

Results

• Increased overall Star rating by 1 star (from 3.5 to 4.5) for both contracts, with significant improvements in key Part D measures and CAHPS measures.
• Increased all part D measures by 1% or 2% for both HMO and PPO plans, including:
  • D08: Medication Adherence for Diabetes Medications
  • D09: Medication Adherence for Hypertension
  • D10: Medication Adherence for Cholesterol
  • D12: Statin Use in Persons with Diabetes

Sources

1. https://www.kff.org/medicare/nearly-7-in-10-medicare-beneficiaries-did-not-compare-plans-during-medicares-open-enrollment-period/