The State of Star Ratings

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amongst ourselves about past “best practices” that have become “industry standard” (and those that are completely out of date).

One of this year’s resounding themes is the certainty Star Ratings are currently very uncertain. While that’s always been the case to some degree, the current degree of uncertainty is unprecedented. With the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) new pressure on providers and the changes expected from Secretary Price and Administrator Verma, Medicare Advantage plans are now beginning to think differently than in the past. Innovators are innovating despite, and maybe because of, this uncertainty – because high-quality healthcare and excellent customer service produce positive return on investment, regardless of the changes the Centers for Medicare & Medicaid Services (CMS) eventually makes to Star Ratings. And when designed well, high-quality healthcare and excellent customer service likely drive positive Star Ratings with minimal incremental cost. This requires careful introspection to make sure what we are doing aligns with our “why.”

For my friends who weren’t able to make it to the Forum, here’s what we heard throughout the week:

Improving Star Ratings requires more careful planning than ever before. In the past, plans invested heavily in new tactics and interventions in the hopes 5-star performance would follow. In many cases, this created quick lift, but sustained 4-star performance remains elusive until we dig deep and better support the specific needs of hard-to-impact members and providers. Though “big data” is clearly now passé, Star Ratings-centric analytics are emerging.  Beyond Healthcare Effectiveness Data and Information Set (HEDIS®) chase lists and Acumen reports, we can now evaluate and develop a plan to meet each member’s Star Ratings needs holistically every time we have the privilege of intervening with them (simultaneously for both Star Ratings and Risk Adjustment). We can now identify the right person at the right time so we can conduct the right intervention to achieve the right outcome. But success still requires purposeful planning, a commitment to person-centered care, and Star Ratings-centric intelligence.

Member experience matters more than ever. In the past few years, plans have done a great job of talking at members rather than working with members to improve Star Ratings. The suite of interventions and tools available to members is generally robust, but with the low-hanging fruit now gone, improving Star Ratings requires investments in meaningful communications and meaningful interventions (both in the home and in clinical settings).  Improving a member’s health in a way that is pleasing to the member often requires more services, more collaboration, more highly-coordinated social and in-home support, and more persistence. Now, more than ever, it’s helpful to remember improving Star Ratings is both a marathon and a sprint.

We are all in this together. With competing priorities and sweeping changes occurring in other segments of the industry, it is common for staff to be consumed with day-to-day activities and even more common for staff to be emotionally attached to existing activities and interventions even when they may not be achieving Star Ratings goals. Despite the hectic environment, pause to take a “temperature check” on your Star Ratings work plan and strategies. Be honest about what’s working and what isn’t, and embrace change. Use your network of expert colleagues to learn from each other – by learning what’s working in other parts of the country (and why), we can all help each other succeed.

If your Star Ratings strategy is sound, focus on execution. Once the Star Ratings strategy has been set and the resulting business decisions made, execution is the magic bullet.   Execution isn’t just checking things off of a “to do” list; meaningful interventions with successful outcomes require significant planning and careful attention to detail in building workflows – from pre-intervention planning to conduct of an intervention to follow-up with providers.

We know this is not easy. Whether you need Star Ratings-centric analytics to support your Star Ratings strategy or an objective evaluation of your Star Ratings work plan to make sure you’re keeping pace with the industry, we can help. For additional information, please contact me directly at

We are currently locking in dates and our new venue for next year’s event. Stay tuned!


The Gorman Health Group 2017 Forum concluded last week in New Orleans with over 200 of our closest clients and partners. John Gorman, our Executive Chairman, provides key takeaways from the event here. Make sure to join us next year!


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Melissa Smith
Melissa Smith

Melissa Smith is Senior Vice President of Stars & Strategy at Gorman Health Group, LLC (GHG). Melissa’s team helps clients improve performance within quality ratings systems such as Star Ratings, improve health outcomes and the member experience, evaluate market dynamics and opportunities, optimize distribution channels, and supports our clients’ strategic planning needs.

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