Topic: Star Ratings

Insights From CMS’ Annual Request For Comments For Star Ratings

Melissa Smith

Despite the seismic transition underway in Washington, the now-annual ritual of CMS’ Request for Comments on Proposed Enhancements to the 2018 Star Ratings program will be remembered not for noteworthy new Star Ratings program information but rather for the absence of significant new insights or new measures.

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Leverage Your MOC to Improve Star Ratings & Optimize Risk Adjustment Performance

Mayling Naputi

The Model of Care (MOC) represents the backbone of a health plan’s operational infrastructure and offers powerful potential through which to drive quality improvement, service excellence, and improved health outcomes

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PBM-Supported Part D Measures Impact Quality Bonus Payment Revenues

Lisa Erwin

Regulatory time frames around coverage determinations and appeals have existed since the inception of the Part D benefit. Timely access to medications has been a hallmark of the “member protective” stance the Centers for Medicare & Medicaid Services (CMS) has taken since Day 1. So how is it, even 10+ years into the delivery of the program, compliance with these time frames continues to be the bane of health plan Compliance and Star Ratings teams?

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The 2017 Star Ratings: A Contrast Between Macro Versus Micro

Melissa Smith

The more things change, the more they stay the same. Despite the many, often significant, changes amidst plan-specific 2017 Star Ratings, there is a surprising amount of stability in the 2017 Star Ratings. Stable performance is evident at the macro level: Read more

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Star Ratings Plan Preview #2: 2017 Trends to Improve 2018 Scores

Melissa Smith

With the Centers for Medicare & Medicaid Services (CMS) release of 2017 2nd Plan Preview Star Ratings and updated 2017 Technical Notes, the Star Ratings “busy season” is officially in high gear.

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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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