Noteworthy declines in Star Measures: Ensure a 4-Star Performance

With 5% of revenue contingent on achieving at least 4 Stars, the stakes have never been higher for Medicare Advantage plans. Within the 40% of plans earning at least 4 Stars in 2015, plan leaders are celebrating their return on investment from quality improvement initiatives and other Stars-impactful activities. But for the 135 plans on the Stars bubble at 3.5 Stars, and the 102 plans earning 3 or fewer Stars in 2015, the race is on.

Although performance continued to improve on most screening measures and on measures within the plans’ control in 2015, ratings declined on 15 of the 46 Star measures in 2015. The most noteworthy declines occurred on the following measures, all of which require significant coordination across provider , and pharmacy networks, plan personnel and members:

  • Three of five diabetes care management measures (with two measures dropping by more than one-quarter star each, and declines on both of the triple-weighted Part C intermediate outcomes measures associated with diabetes),
  • All three triple-weighted medication adherence measures and the high risk medication measure,
  • Care coordination and customer service measures.

In addition, four additional measures, which are heavily dependent on effective care coordination as well as member education, continue to perform under 3 Stars:

  • Improving or maintaining mental health,
  • Special needs plan care management,
  • Improving bladder control,
  • Osteoporosis management in women who have had a fracture.

Since enrollment in high performing plans continues to grow, and dramatic improvements have occurred in low-performing plans, CMS is likely to continue driving quality and accountability of physicians, hospitals, and other providers through the ever-evolving Medicare Advantage Star Ratings program.

As plans race into the unavoidable 4th quarter ‘Stars crunch,’ now is an ideal time to ensure that adequate workplans, budgets and resources are available to enable 4 Star performance. If your plan is striving to achieve 4 Stars, Gorman Health Group is ready to help! From evaluating organizational strategy to developing and optimizing tactical Star ratings workplans, our team of experts has a long history of success helping health plans achieve Star ratings success.

 

Resources

Gorman Health Group can evaluate your Star Ratings approach and identify tactics you can begin implementing immediately to integrate initiatives, eliminate redundancies, and build an enterprise-wide Star management structure. We can help you identify clinical, operational, and networking opportunities to increase your score for 2016 and beyond. Visit our website to learn more >>

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Jane Scott
Jane Scott

Jane Scott is Senior Vice President of Population Health Management and Clinical Innovations at Gorman Health Group (GHG). In this role, she is responsible for leading GHG’s Clinical Innovations practice area. Jane brings GHG clients 37 years of experience in healthcare as one of the industry leaders on the topics of the Centers for Medicare & Medicaid Services (CMS) Special Needs Plans (SNPs), development and implementation of Models of Care (MOCs), as well as the Star Ratings Quality Bonus Payment Program. Her experience expands to the areas of quality improvement (QI), utilization and medical management, claims operations, and provider/associate education.

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