3 Key Points to Consider While Prepping Strategic & Star Ratings Objectives for 2020

As we near the end of the year, it’s a great time to both think about the hard work we’ve done in the last year as well as our expectations and plans for the new year. Here are 3 key things to think about during the next few weeks while we usher in 2020:

#1. Think about the strategic initiatives and major projects you attempted to implement in 2019 but were unsuccessful. For those that still need to be implemented:

  • If lack of financial resources were the barrier, were funds budgeted in 2020?  If not, can additional funding still be sought?
  • If internal resistance, competing priorities, or lack of leadership support was the barrier, can the initiative(s) be re-represented to leadership early in Q1 to garner support so that another year doesn’t slip by without addressing these important needs.

#2. Now that we’ve had one full year of member experience measures being 2x-weighted, think back on all that you’ve learned this year about your operations.

  • What areas have you uncovered that are in need of strategic redesign, a “next generation” approach to servicing or supporting members, and/or areas known to be unsatisfying for members? Are solutions to these issues included in early 2020 work plans?
  • CAHPS is now worth >20% of the overall Star Rating for most plans.  Do your 2020 Stars budgets and work plans allocate at least 20% of staff time and budgets towards CAHPS?

#3. Think about your readiness for the significant Star measure changes in 2020. 

  • Are all of your reporting and projection tools ready for the new specifications which will be used for the Controlling Blood Pressure measure in 2020? Have your internal and provider teams completed all of their adjustments and adaptations to ensure your providers are prepared for the new measure specifications? Are your internal teams and data infrastructure prepared to report (and leverage) the administrative measure data beginning in January?
  • CMS new rulemaking requires a 2-year notice period for the addition of new measures, which sounds like a long time—but 2020 marks the second year of our notice period to prepare for the return of the significantly changed Plan All-Cause Readmissions measure, which returns as a Star measure during the 2021 measurement period. Have your teams completed their internal preparations for the return of this measure so that final implementation can be completed in 2020? If not, since the ROI of reducing readmissions is unarguable, how can budget and staff resources be secured to complete this work as early as possible in 2020?

From helping plans implement strategies for new measures to developing a new path to 4+ stars that accounts for the many changes in MA, we can help. For additional questions and inquiries about how GHG can support your needs, please contact me at msmith@gormanhealthgroup.com.

Melissa Smith
Melissa Smith

Melissa Smith is Senior Vice President of Stars & Strategy at Gorman Health Group, LLC (GHG). Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports our clients’ strategic planning needs.

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