The Voice of Melissa Smith

Melissa Smith

About Melissa Smith

Melissa Smith is the Senior Vice President of Sales, Marketing, Strategy & Stars at Gorman Health Group (GHG). She brings more than 20 years of healthcare experience to GHG, more than five of which have been in an operational leadership capacity in Medicare Advantage (MA) and Part D health plans.

Is Your Organization on Track to Achieve a 4-Star Rating?

Melissa Smith

As the Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) season comes to a close, we now sit in the uneasy waiting period while the Centers for Medicare & Medicaid Services (CMS) finalizes the 2019 program technical details, survey responses, and measure cut points. Perhaps the most challenging question to answer at this point in the year is: “Are we on track to achieve a 4-star rating?” Though there is no simple answer to this question for a few more months, this is an opportune time to evaluate whether your culture, work plans, and initiatives have you well positioned for strong 2020 ratings. What can you do while we wait? Read more

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CMS Doubles Down on Member Experience

Melissa Smith

At Gorman Health Group, we have the privilege of collaborating with organizations across the full spectrum comprising our members’ experience – from health plans and providers to vendors and pharmacy benefit managers (PBMs) – and though almost every person I talk to in every type of organization strives to create excellent member experiences, many struggle to successfully do so. The Centers for Medicare & Medicaid Services (CMS) recent pledge to put patients first in all of their programs has changed the calculus of “the member experience” in Medicare Advantage (MA). We’ve heard these words for years, but this time it’s real.

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The 2019 Final Call Letter: Stability & No Unexpected Surprises in Star Ratings

Melissa Smith

The Centers for Medicare & Medicaid Services (CMS) Star Ratings updates in the 2019 Final Call Letter offer a true gift to Medicare Advantage (MA) plans. No significant changes were introduced from the changes previously announced in the Advance Notice, with the interesting surprise CMS still has not removed any of the “topped out” measures or made changes intended to support Administrator Verma’s Patients Over Paperwork or Meaningful Measures vision. Assuming no surprises are introduced when the technical notes are released, CMS provides MA plans with the gift of stability and no unexpected surprises in Star Ratings.

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New Year, New Star Ratings Measures

Melissa Smith

As we near the end of the first quarter, most of us have recovered from the now-annual “4th quarter Stars fire drill” and finished onboarding new members. There is no rest for the weary in Star Ratings, and it’s time to get focused on some of the issues and measures not easily tackled during busier times of the year.

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Advance Notice Update: Star Ratings

Melissa Smith

With the much anticipated Advance Notice now in hand, we have our first glimpse into the Centers for Medicare & Medicaid Services (CMS) proposed changes to the 2019 and 2020 Star Ratings. Though CMS hasn’t yet proposed any noteworthy changes (or removed any measures) as part of its “Meaningful Measures” or “Patients Over Paperwork” initiatives, there are plenty of proposals to be carefully considered. Here’s a quick summary of CMS’ proposals impacting the 2019 Star Ratings: Read more

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CMS Request for Comments on Star Ratings are due January: Are You Ready?

Melissa Smith

With comments on the Medicare Advantage (MA) and Prescription Drug Benefit Program (Part D) Proposed Rule for 2019 due by January 16, 2018, we’ve received numerous requests for help distilling the Stars elements from the Centers for Medicare & Medicaid Services (CMS’) 713 pages of proposed regulations. Yep, we’ve read all 713 pages, and CMS is seeking feedback on numerous potential adjustments to the Star Ratings programs in the coming years.  CMS has, and continues to, demonstrate its willingness to consider plan feedback on proposed changes, and plans should seize this opportunity to be “on the record” so CMS can make well-informed decisions as it adjusts the program in the coming years.

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Influencing Your 2019 Star Ratings: Every Day Matters

Melissa Smith

With the recent release by the Centers for Medicare & Medicaid Services (CMS) of 2018 Star Ratings to health plans, the now-annual “4th quarter Star Ratings fire drill” is officially underway.  Whether you dropped below the 4-star threshold required to earn quality bonus payments, or you hit 4 stars and are hoping to sustain it, the next six weeks are critical to your success. But with only about 90 days remaining to connect members with the care they need for your success, every day and every decision matters.

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