Topic: Star Ratings

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

Leave a comment | Share | |

Influencing Your 2019 Star Ratings: Every Day Matters

Melissa Smith

With last week’s release by the Centers for Medicare & Medicaid Services (CMS) of draft 2018 Star Ratings to health plans, the now-annual “4th quarter Star Ratings fire drill” has officially begun.  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 to eight 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.

Read more

Leave a comment | Share | |

Evaluating Star Ratings Performance Data

Melissa Smith

September marks an exciting season for Star Ratings as 4th quarter work plans and 2018 budgets are finalized. For these investments to be impactful, plans must carefully evaluate Star Ratings performance data to ensure action plans address the following questions: Read more

Leave a comment | Share | |

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!

Read more

Leave a comment | Share | |

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

Leave a comment | Share | |

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:

Read more

Leave a comment | Share | |

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.

Read more

Leave a comment | Share | |