Topic: Star Ratings

Is Your Organization on Track to Achieve a 4-Star Rating?

Melissa Smith

As the Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) season comes to a close, we now sit in the uneasy waiting period while the Centers for Medicare & Medicaid Services (CMS) finalizes the 2019 program technical details, survey responses, and measure cut points. Perhaps the most challenging question to answer at this point in the year is: “Are we on track to achieve a 4-star rating?” Though there is no simple answer to this question for a few more months, this is an opportune time to evaluate whether your culture, work plans, and initiatives have you well positioned for strong 2020 ratings. What can you do while we wait? Read more

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CMS Doubles Down on Member Experience

Melissa Smith

At Gorman Health Group, we have the privilege of collaborating with organizations across the full spectrum comprising our members’ experience – from health plans and providers to vendors and pharmacy benefit managers (PBMs) – and though almost every person I talk to in every type of organization strives to create excellent member experiences, many struggle to successfully do so. The Centers for Medicare & Medicaid Services (CMS) recent pledge to put patients first in all of their programs has changed the calculus of “the member experience” in Medicare Advantage (MA). We’ve heard these words for years, but this time it’s real.

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Takeaways from the Gorman Health Group 2018 Client Forum

John Gorman

The Gorman Health Group 2018 Client Forum concluded last week in Las Vegas with over 300 of our closest clients and partners. As we enter our 22nd (!) year, we returned to the Red Rock Resort where a great time and shared learnings were had by all.

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The 2019 Final Call Letter: Stability & No Unexpected Surprises in Star Ratings

Melissa Smith

The Centers for Medicare & Medicaid Services (CMS) Star Ratings updates in the 2019 Final Call Letter offer a true gift to Medicare Advantage (MA) plans. No significant changes were introduced from the changes previously announced in the Advance Notice, with the interesting surprise CMS still has not removed any of the “topped out” measures or made changes intended to support Administrator Verma’s Patients Over Paperwork or Meaningful Measures vision. Assuming no surprises are introduced when the technical notes are released, CMS provides MA plans with the gift of stability and no unexpected surprises in Star Ratings.

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How Will Your MTM Programs Impact Star Ratings in 2018?

Lisa Erwin

In 2015, plans were met with the first “a-ha” moment when the Centers for Medicare & Medicaid Services (CMS) published the 2016 Star Ratings Medication Therapy Management (MTM) Comprehensive Medication Review (CMR) completion Star Ratings cut points indicating, at least when it came to delivering a completed CMR to a member, some plans were clearly outperforming others. Since then, the stakes have continued to be raised on MTM vendors or those conducting MTM in-house to meet the challenge of how to cost effectively improve their delivery of completed medication reviews. This is especially challenging given the varying nature of plan delivery types and the vastly different member demographics for whom they provide services.

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New Year, New Star Ratings Measures

Melissa Smith

As we near the end of the first quarter, most of us have recovered from the now-annual “4th quarter Stars fire drill” and finished onboarding new members. There is no rest for the weary in Star Ratings, and it’s time to get focused on some of the issues and measures not easily tackled during busier times of the year.

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Advance Notice Update: Star Ratings

Melissa Smith

With the much anticipated Advance Notice now in hand, we have our first glimpse into the Centers for Medicare & Medicaid Services (CMS) proposed changes to the 2019 and 2020 Star Ratings. Though CMS hasn’t yet proposed any noteworthy changes (or removed any measures) as part of its “Meaningful Measures” or “Patients Over Paperwork” initiatives, there are plenty of proposals to be carefully considered. Here’s a quick summary of CMS’ proposals impacting the 2019 Star Ratings: Read more

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