Topic: Clinical

Influencing Your 2019 Star Ratings: Every Day Matters

Melissa Smith

With the recent release by the Centers for Medicare & Medicaid Services (CMS) of 2018 Star Ratings to health plans, the now-annual “4th quarter Star Ratings fire drill” is officially underway.  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 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.

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2018 Star Ratings: Top Takeaways

Melissa Smith

In case you missed our 2018 Star Ratings webinar yesterday, here are some of our top takeaways:

Strategy is vital for sustained success. Many plans’ Star Ratings success is the product of multi-year, strategic investments to improve infrastructure, processes, culture, and execution. When Star Ratings efforts are designed only with the “short-term win” in mind, we are often limited to narrowly-defined tactics and projects – however, when they are strategically designed, Star Ratings activities can be hardwired into corporate culture and standard processes so strong Star Ratings are simply the measurement of high-quality service delivery.

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A Decade of Lagging Medicare Part D MTM Services

Wayne Miller

After a decade of Medication Therapy Management (MTM) programs, nearly every Medicare Advantage plan still misses a huge opportunity to capitalize on it.

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Off-Cycle MOC Submissions – Is It Time?

Anita McCreavy

Remember, your plan must be operating from an approved Model of Care (MOC).

The off-cycle submission process allows for substantial changes such as fundamental organizational changes essential to the MOC process and functions; for example, changes to an organization’s MOC narrative that occur between approval periods (e.g., year 2 of a three-year approval) and have not expired.

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2018 Star Ratings Offer Valuable Insight into Competitive MA Industry

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

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Care Management Interdependencies

Debra Devereaux

It’s impossible to achieve reasonable and prudent member care management in a vacuum. The three-legged stool supporting care management includes medical management, risk assessment, and medication therapy management. The care manager cannot make reasonable decisions about a member’s care unless he or she has knowledge of the member’s medical management history and current status, medication history and current status, and diagnostic history and current status based on risk assessment.

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Star Ratings – First Plan Preview is Underway!

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!

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