Topic: Star Ratings

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 | |

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?”

Read more

1 Comment | Share | |

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amongst ourselves about past “best practices” that have become “industry standard” (and those that are completely out of date).

Read more

Leave a comment | Share | |

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.

Read more

Leave a comment | Share | |

The Sun Shines on Medicare Advantage Payments and Policy in 2018

John Gorman

Yesterday the Trump Administration released the final notice of payment policy for Medicare Advantage for 2018, and it was better than expected. It’s a rare ray of sunshine for health plans and their members since Trump took office with a vow to repeal ObamaCare, and confirms that Medicare Advantage (MA) is the only safe game in all of health insurance these days.

Read more

Leave a comment | Share | |

Adjusting Star Ratings for Audits and Enforcement Actions

Regan Pennypacker

Within the Draft Calendar Year 2018 Call Letter, the Centers for Medicare & Medicaid Services (CMS) acknowledged the valuable comments received from the industry related to the use of audit findings and enforcement actions in the Star Ratings Program. As a result of those comments, CMS proposes a revision of the Beneficiary Access and Performance Problems (BAPP) measure.

Read more

Leave a comment | Share | |