As the Centers for Medicare & Medicaid Services (CMS) embarks on its Patients Over Paperwork initiative to better focus quality measurement in all programs on meaningful measures, this is an ideal time for Medicare Advantage plans to ensure they are using their data in ways which support CMS’ plans to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience.
According to a recent study published in the Annals of Internal Medicine: “Family physicians spend 27% of their day with patients, and 49% of their day on administrative paperwork.” Anecdotally, we hear this same experience consistently throughout the industry, and it’s only a matter of time until CMS makes long overdue changes to the measures included in Star Ratings to bring this back into balance. Plans should expect CMS to focus less on process and more on outcomes as all signals point to CMS revising quality measures to empower consumers, reduce the number of measures, and better focus on high-priority issues.
This transition won’t be easy, but by arming member-facing staff with advanced quality metrics and predictive models, we can ease this transition and reduce the “trial and error” that so often occurs with this type of evolution. From identifying the right providers for the right interventions to identifying the right members for the right interventions, plans can now more scientifically invest limited resources into the specific people (providers or members) most in need of more support. When done well, such a data-driven approach enhances cross-functional integration and supports holistic, member-pleasing interventions that improve outcomes and maximize return on investment.
Whether you need a one-time run of Star Ratings reports and analytics to develop a data-driven Star Ratings work plan or ongoing access to Star Ratings-centric analytics to support your organization’s Star Ratings program, we can help. Contact me at firstname.lastname@example.org for more information about how Gorman Health Group can help you develop a data-driven Star Ratings action plan.
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