Topic: Star Ratings

An “October Surprise” in Medicare Advantage Star Ratings

John Gorman

Each year, one of the most anticipated announcements in the Medicare Advantage (MA) industry is the Star Ratings and program technical guidance for the coming year from the Centers for Medicare & Medicaid Services (CMS). This year’s includes an “October Surprise:” a little-known methodological change that could force dozens of 4- to 5-Star-rated plans to lose their hard-fought bonuses and rebates.

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Making Order from Chaos

Nancy Djordjevic

“Big data” is often described in terms of colorful dashboards and a roomful of SQL programmers.  Gorman Health Group (GHG) thinks of it as a symphony of moving parts that all play a role in managing quality healthcare.

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Star Ratings: Medication Management Is Not Just for D Ratings Anymore!

Lisa Erwin

As a pharmacist and Star Ratings Senior Consultant for Gorman Health Group, whenever I am asked to provide insight on how to achieve or maintain Star Ratings success, the conversation has been limited to the “D” part of the metrics, and the folks involved with Medicare Advantage (MA) and Healthcare Effectiveness Data and Information Set (HEDIS®) kind of glaze over and mumble something like, “That’s for the Pharmacy folks to deal with.” That attitude has always been somewhat befuddling to me considering the historical and ever-increasing impact of appropriate clinical management of medications on many HEDIS® measures and the quality conversation in general. Equally confusing to me has been the willingness of many pharmacists to relinquish the ownership of the medication-related HEDIS® measures to Quality, Case Management, or other teams.

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Evolution Through Strategy: Pinpointing Growth Opportunities

Nancy Djordjevic

My last article explained the choice of Medicare Advantage (MA) health plans to evolve or disappear. Evolution is certainly the preferable choice, so let’s examine the steps needed to do so.

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New Challenges in Network Development

Elena Martin

The sun is shining, kids are heading back to school, and fall will be here before we know it. Now is the perfect time to start planning for your network expansion needs. Plans need to be even more vigilant in managing their largest asset. Regardless of the size and scope of the organization, your plan’s network adequacy and accessibility is a cornerstone of any new initiative.

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First Plan Preview of 2017 Star Ratings Data

Melissa Smith

It’s official — the Star Ratings busy season is officially underway. The Centers for Medicare & Medicaid Services (CMS) recently notified plans of the first preview period for the 2017 Star Ratings data.

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Star Ratings: 10 Years, 10 Lessons

Melissa Smith

The Star Ratings program celebrates its 10th birthday this year. In honor of the first decade of quality ratings systems within managed care, and to celebrate the many lessons we’ve learned during these formative years of the Star Ratings program, here are 10 of our top lessons from the first 10 years of the program. Read more

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