Topic: Star Ratings

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.

Read more

Leave a comment | Share | |

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.

Read more

2 Comments | Share | |

January 1 Is Here

Debra Devereaux

“There’s no harm in hoping for the best as long as you’re prepared for the worst.”—Stephen King

Read more

Leave a comment | Share | |

Connecting the Dots: The Impact of Health Disparities on Star Ratings

Melissa Smith

Healthcare quality improvement efforts have traditionally looked at healthcare policy, access to care, and the practice of medicine as some of the key drivers to improve clinical quality performance.  Significant advances have been made in recent years to expand and enhance access to high-quality care, to ensure adherence to evidence-based clinical practice guidelines, and to support standardized care pathways while still incorporating patients’ and practitioners’ decisions and preferences into the care planning process.  But as quality improvement efforts in Medicare Advantage have matured, we’ve hit a performance plateau.  Star Ratings measure performance has declined or stagnated on numerous Medicare Advantage quality measures:

Read more

Leave a comment | Share | |

21st Century Cures Bill Slips in Some Changes to Medicare and Medicaid Programs

Olga Walther

What do medical research, Medicaid provider adequacy, and Star Ratings have in common? The 21st Century Cures Act. On January 7, 2016, Congress overwhelmingly passed this piece of legislation – a package of proposals which will provide $6.3 billion for medical research over the next decade.

Read more

1 Comment | Share | |

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.

Read more

Leave a comment | Share | |

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

Read more

Leave a comment | Share | |