The introduction of a Five-Star Quality Rating System from the Centers for Medicare & Medicaid Services (CMS) for Medicare Advantage (MA) Plans has resulted in opportunities for high-performing organizations to reap significant financial compensation and the ability to offer supplemental benefits while underperforming organizations risk fines, notices to their current members, potential removal of contract, and other punitive actions.

With so much at stake, finding ways to improve or maintain an organization’s star rating has become a critical component of every MA Plan’s strategic planning. The use of rewards and incentives programs to drive member engagement is a proven strategy to impact star ratings that has helped plans to put the focus on closing gaps in care.

Entertainment® Rewards & Incentives health care team recently produced a white paper, which provides a brief overview of the current Five-Star Quality Rating System and offers recommendations for organizations that want to develop and implement a robust rewards and incentives program. The following is an excerpt from the white paper:

Successful rewards programs:

  • Drive wellness initiatives among members
  • Inspire healthier, more active lifestyles
  • Generate long-term cost savings for plan participants and insurers
  • Improve satisfaction and member retention
  • Strengthen cooperation and compliance with CMS measures
  • Impact star ratings, bonuses, and rebates

The challenges

Building an effective rewards program as an incentive to drive participation in star measurements presents several challenges for organizations. A program with multiple rewards can be a complicated, costly endeavor, which is difficult to implement and hard to execute. Another hurdle is developing high-value, low per-customer cost incentives that are compelling enough to influence member participation and behavior while complying with government regulations.

Most importantly, organizations must also ensure that their rewards programs are compliant with the established guidelines from CMS. Failure to comply with these guidelines can result in substantial penalties and potential sanctions.

How to implement a rewards program

When developing rewards and incentives programs there are several factors to consider:

  • Universal appeal – Is there something relevant for every interest?
  • Consistency with brand – Does it drive energy and match corporate values?
  • Cost effectiveness – Does it improve the bottom line, with strong ROI potential?
  • Shelf life– Will the reward engage members for the long haul? Can it be reinforced?
  • Ease of implementation – What internal resources are necessary? Where can I get support? How long will it take to implement?

Establish benchmarks for each measurement to determine the success of the rewards program. These measures of success will vary depending on the specific goals of an organization, but often these benchmarks are built around financial models and establish specific goals related to increases in documented member participation in targeted activities.

Examples of benchmarks include:

  • Increase wellness/HRA* visits by _%
  • Increase diabetes screenings by _%
  • Increase mammograms by _%

*Note: Rewards for Completing a Health Risk Assessment (HRA). CMS includes the completion of an HRA as a permitted health-related activity in an RI Program beginning in 2019.

Rewarding with savings and experiences

One of the more effective approaches to developing a member rewards and incentives program has been the use of relevant discounts and savings opportunities in the form of high-value coupon booklets or online savings.  These rewards can include discounts for travel, shopping, events, activities, healthy dining, and entertainment for completing the measures used in the Five-Star Quality Rating System.

By offering members savings on activities that they enjoy, such as dining, bowling, travel, shopping, or golf, MA organizations can encourage members to live a healthier, more active lifestyle, which often has positive mental and physical health implications. These are both heavily-weighted measures in the Five-Star Quality Rating System. In addition, offering members savings they can use to enhance their lives and stretch their budgets also helps a MA organization add value to their relationship.

Those savings are especially importation to seniors. Fifty percent of web site traffic on is from the 55+ demographic

The typical 10 percent off for 55+ seniors is not as prevalent as it used to be. Some retailers are doing away with senior discounts. Give your members access to discounts in your communications with them and they will thank you for it!

For more information, read the entire white paper here.