Topic: Star Ratings

CMS Proposes Several Key Changes for Star Ratings in 2018 Medicare Advantage (MA) Draft Call Letter

Melissa Smith

The potential changes to the Star Ratings program announced by the Centers for Medicare & Medicaid Services (CMS) last week in the annual Advance Notice may look minor at first glance but are sending shock waves through Star Ratings teams this week. Although most changes proposed for the 2018 Star Ratings (for which measurement periods are generally already complete) are unsurprising, CMS has proposed several key changes worthy of feedback during the comment period: Read more

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How to Maximize Your Medicare Advantage Website Strategy

Angela Fox

How was your Annual Election Period (AEP)? Have you evaluated your performance? Do you need to enhance your sales and marketing strategies? Now is the time to recognize and appreciate your 2017 successes as well as confront your shortcomings.

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Healthcare Analytics – The New Age of Technology Innovation

Jessica Smith

It’s no surprise healthcare analytics is a hot topic in the insurance industry today. New and enhanced Centers for Medicare & Medicaid Services (CMS) regulations that govern healthcare have become more aligned with technical solutions, moving health plans to adopt more cutting-edge analytics to drive decisions. With the passing of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physicians and physician groups will start to move more towards aligned analytics as well. The need to look at microanalysis increases each day, so in a day and age driven by data and technology, what’s next for healthcare analytics?

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Are You Ready for the Medicare Advantage Advance Notice & Draft Call Letter?

Olga Walther

As you may recall, in December 2015, the Securing Fairness in Regulatory Timing Act extended the 45-day notice period for the Medicare Advantage Advance Notice & Draft Call Letter (draft call letter). This means the industry now has 60 days to review the proposed payment and benefit changes, getting a few more weeks to digest the minutiae of the draft call letter. It also means we are now expecting the draft call letter to come out on February 1, earlier than the typical mid-February release.

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Getting a Jump Start on Measures

Melissa Smith

Every January, we return from the holidays facing a Star Ratings conundrum. We must decide how much to invest in solidifying our 2018 Star Ratings while simultaneously looking into the Centers for Medicare & Medicaid Services (CMS) crystal ball to deciding what (and how much) to begin investing in our 2019 Star Ratings. We’re still reporting our 2016 performance (even without yet knowing exactly which measures CMS will include in the 2018 ratings) while we are developing 2017 dashboards to monitor our 2019 Star Ratings. And all of this while adjusting to benefit design changes, acclimating new members, and readying ourselves for the impending insights from the Advance Notice and Call Letter.

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The Trump De-Regulators and Medicare Advantage

Steve Balcerzak

Hmm, you’re asking what will the Trump de-regulators do to Medicare Advantage? Given the confusion about ObamaCare non-replacement for three years and the selection of a Medicaid maven for Administrator, we haven’t heard much about Medicare Advantage and Part D. However, Trump said he wants a list of wasteful and unnecessary regulation. Even with that, we may not see a lot of actual regulatory change during 2017 in either of these programs. Changing regulations in a major way takes too much time to propose, review, and finalize anything of substance in a short period. However, there are other actions the new Administrator can take. First and foremost, de-regulators are interested in slowing the process or moderating its effects, so here are some potential actions.

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The New “80/20 Rule” in Government Health Programs

John Gorman

The New “80/20 Rule” in Government Programs

Everyone in health finance and policy knows the “80/20 Rule:” 20% of patients account for 80% of health expenditures. It’s also well-established that about one-third of health outcomes are determined by genetics and access to healthcare. That means two-thirds of outcomes are attributable to social determinants of health. For 2017, we need a new 80/20 rule for Medicare Advantage and Medicaid health plans and their delegates: 80% of the services we provide beneficiaries should address social determinants and make the health services we provide more effective.

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