Topic: Star Ratings

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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The True Path to Improving the Medicare Member Experience

John Gorman

I’ve been struck lately by two new research reports that demonstrate improving the member experience is the top challenge facing Medicare Advantage plans. First, JD Power is out with its 2017 Medicare Advantage Satisfaction Rankings. Among the results: Read more

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Preparing for First Plan Preview of 2018 Star Ratings Data

Melissa Smith

While many of us have been enjoying the long days of summer and catching our breath after the Healthcare Effectiveness Data and Information Set (HEDIS®) season, the Centers for Medicare & Medicaid Services (CMS) has been hard at work preparing for the annual ritual of releasing the latest Star Ratings and program changes. Here’s an idea of what we can expect over the next few months:

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Evolve from Restrictive to Supportive Medical Management, or Die

John Gorman

I am continually amazed by how many health plans in Medicare Advantage (MA) and Medicaid still cling to restrictive, “Dr. No”’90’s-style managed care practices like pre-authorizations, referrals, and concurrent review. With massive policy changes looming in Medicaid, and the influence of Star Ratings in MA greater than ever, health plans may soon have a gun to their heads: evolve medical management from restrictive to supportive, or die.

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A New Source of Capital for Star Ratings and Clinical Innovations

John Gorman

For years, every conversation we’ve had with clients about improving Star Ratings and launching clinical innovation projects involved a common barrier to progress: money. So for months, we have been working to bring a new source of capital to the health plan and provider industries to help drive this evolution, called social impact investing. We are getting some early successes and can ask, “If money was no object, what initiatives would you chase?”

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The State of Star Ratings

Melissa Smith

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).

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Takeaways from the Gorman Health Group 2017 Client Forum

John Gorman

The Gorman Health Group 2017 Forum concluded last week in New Orleans with over 200 of our closest clients and partners. As we enter our 21st year, we returned to where it all began for us, with a little startup called Peoples Health, our first and closest client who now dominates southern Louisiana. The Forum ended the day JazzFest 2017 began, so many of us stayed to enjoy the festival and the best of New Orleans heritage and culture.

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