In fine fashion, the Centers for Medicare & Medicaid Services (CMS) surprised industry insiders with its late-night release of draft 2019 Star Ratings to health plans in the wee hours on Friday night. And with that, the inevitable “4th quarter press” is in full swing! The 2019 ratings remind us just how challenging it is to earn 4 stars! For example, among other things, the 2019 ratings include:
- Many dramatic cut point changes: The 2019 Star Ratings reflect dramatic cut point changes. Across all Part D measures, only two individual cut points declined in the 2019 ratings. Every other cut point either remained the same or increased – and the cut points for two of the three medication adherence measures jumped significantly. On Part C measures, though, there is a relatively equal number of cut point increases as decreases, many are large and defied mathematical prediction models.
- Numerous nuanced measurements: The range between the 1- and 5-star cut points on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) measures remains incredibly small and almost unchanged in the 2019 ratings. As a result, even minor changes to benefits, service interruptions/disruptions, and operational “hiccups” can impact these ratings. At the same time, even minor, well-publicized improvements to benefits and “winning moments” can also influence these ratings. Although these measures seem to meet reasonable definitions of being “topped out,” CMS’ continued emphasis on beneficiary experiences will likely prevent them from being removed from the Star Ratings program anytime soon.
Whether you’re celebrating hitting 4 stars or worried you’re still not doing enough to earn the elusive 4th star, every day and every decision during the remaining days of 2019 matter. Here are a few tips:
- Be intentional. Make sure each staff person knows what they need to do, educate them on how to do it well, and ensure they have the resources needed for success. Ensure executives understand how far away you are from your goal and the investment needed to get there. Ensure your Star Ratings work plan is designed to improve performance on enough measures (and the right measures) to achieve your goal, and shore up performance on outlier measures to generate the largest possible reward factor.
- Ask the right members and providers for exactly what you need. Integrate your data to identify the full picture of your “ask” of a member or provider and prioritize your request to avoid overwhelming them. Collaborate across departments to make sure your members and providers aren’t receiving conflicting or confusing messages.
- Don’t forget the back office. Identify a staff person to identify and resolve any missing claims, encounters, and lab results (and to resolve leakage from hard/soft rejects), verify Healthcare Effectiveness Data and Information Set (HEDIS®) medical record review procedures capture all records and all available nuances, and validate data sources and extracts. Ensure prescription drug events exist for all claims in the drug classes impacting Star Ratings measures and are accepted by CMS.
- Keep it real. Don’t waste time, money, or effort with outdated tactics you know are not accomplishing Star Ratings goals – change course wherever needed before it’s too late!
- Don’t forget your vendors. Star Ratings reflect the inherent business risks associated with outsourcing. Involve Star Ratings subject matter experts in vendor oversight and use joint operating committee meetings to ensure each vendor is supporting Star Ratings needs effectively (including CAHPS® and Health Outcomes Survey (HOS) needs).
Whether you need help developing a data-driven Star Ratings work plan or improving your organization’s Star Ratings, we can help. Contact me at firstname.lastname@example.org to learn more about how we can help.
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