The policy analysis and guidance you need by the experts you trust, daily.
- After Hours
- Agent Oversight
- Brain Food
- Health Insurance Exchanges
- Part D
- Performance Optimization
- Policy & Health Reform
- Prospective Evaluations
- Provider Relations
- Risk Adjustment
- Sales & Marketing
- Star Ratings
- Sharon Willliams on A New Source of Capital for Star Ratings and Clinical Innovations
- William on Will Trump and Price Pull Out the Scalpels for Star Ratings?
- Bobby on January Release of the Draft MMG – Perfect Timing
- Pam Lassila on Best Practices and Common Conditions of Audit Preparation
- Capitol Hill Healthcare Update | Gorman Health Group Blog on What Trump Could Actually Do to ObamaCare, Day One, Without Congress
The Voice of Melissa Smith
About Melissa SmithMelissa Smith is the Vice President of Stars & Quality Innovations 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.
October 12, 2017 | Melissa Smith
The Centers for Medicare & Medicaid Services (CMS) release yesterday of the 2018 Star Ratings offers valuable insights into the significantly competitive Medicare Advantage (MA) industry. Here are just a few early observations and some insight into why it’s important: Read more
September 21, 2017 | Melissa Smith
With last week’s release by the Centers for Medicare & Medicaid Services (CMS) of draft 2018 Star Ratings to health plans, the now-annual “4th quarter Star Ratings fire drill” has officially begun. 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 to eight 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.
August 31, 2017 | Melissa Smith
September marks an exciting season for Star Ratings as 4th quarter work plans and 2018 budgets are finalized. For these investments to be impactful, plans must carefully evaluate Star Ratings performance data to ensure action plans address the following questions: Read more
August 17, 2017 | Melissa Smith
The First Plan Preview period for the 2018 Star Ratings began last week with the Centers for Medicare & Medicaid Services’ (CMS’) release of measure rates and an initial draft of the technical notes. As is always the case, CMS is allowing only a very short review period with all feedback due by THIS FRIDAY, August 18 – so time is of the essence!
July 26, 2017 | Melissa Smith
While many of us have been enjoying the long days of summer and catching our breath after the Healthcare Effectiveness Data and Information Set (HEDIS®) season, the Centers for Medicare & Medicaid Services (CMS) has been hard at work preparing for the annual ritual of releasing the latest Star Ratings and program changes. Here’s an idea of what we can expect over the next few months:
May 4, 2017 | Melissa Smith
Last week I had the pleasure of spending a few days with some of the industry’s leading experts at our annual client forum. One of my favorite things about this now-annual tradition is the opportunity to look beyond the Star Ratings measures to share innovation experiences, hear more about emerging best practices, and level-set amongst ourselves about past “best practices” that have become “industry standard” (and those that are completely out of date).
April 20, 2017 | Melissa Smith
Few would argue Star Ratings is overdue for evolution. With almost 50 Star Ratings measures, many having been in the program for years, and Secretary Price and Administrator Verma both positioned to make their mark on Medicare, change is imminent. But change is also difficult, a fact acknowledged by the Centers for Medicare & Medicaid Services (CMS) when it reversed course in the 2018 Call Letter on several proposals included in the Advance Notice.