Topic: Star Ratings

CMS Releases Part II of the Medicare Advantage Advance Notice & Draft Call Letter

Olga Walther

On February 1, 2018, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Advance Rate Notice (Part II) and Draft Call Letter. CMS estimates an expected increase of 1.84% to payments in 2019. CMS says its estimates do not reflect underlying coding trend, which it expects to increase risk scores by 3.1% in 2019.

Read more

Leave a comment | Share | |

The Outlook for Government-Sponsored Health Programs in 2018

John Gorman

As 2018 and Year 2 of the chaotic Trump Administration kick off, trying to predict what will happen in Medicare, Medicaid, and the Affordable Care Act is as challenging as ever. It’s a midterm election year with terrible headwinds for the GOP, so the legislative calendar is abbreviated, and partisan rancor will peak. That makes it less likely Republicans will get to do much damage but also more likely they will try to serve up red meat for their base, like a return to “repeal and replace.” Congressional leaders, fresh off their billionaire bailout tax bill, are already talking about taking up “reform” (aka cuts) of Medicare and Medicaid and other social welfare programs. The only thing that is certain is 2018 will be another battleground year for government health programs.

Read more

Leave a comment | Share | |

CMS Request for Comments on Star Ratings are due January: Are You Ready?

Melissa Smith

With comments on the Medicare Advantage (MA) and Prescription Drug Benefit Program (Part D) Proposed Rule for 2019 due by January 16, 2018, we’ve received numerous requests for help distilling the Stars elements from the Centers for Medicare & Medicaid Services (CMS’) 713 pages of proposed regulations. Yep, we’ve read all 713 pages, and CMS is seeking feedback on numerous potential adjustments to the Star Ratings programs in the coming years.  CMS has, and continues to, demonstrate its willingness to consider plan feedback on proposed changes, and plans should seize this opportunity to be “on the record” so CMS can make well-informed decisions as it adjusts the program in the coming years.

Read more

Leave a comment | Share | |

Influencing Your 2019 Star Ratings: Every Day Matters

Melissa Smith

With the recent release by the Centers for Medicare & Medicaid Services (CMS) of 2018 Star Ratings to health plans, the now-annual “4th quarter Star Ratings fire drill” is officially underway.  Whether you dropped below the 4-star threshold required to earn quality bonus payments, or you hit 4 stars and are hoping to sustain it, the next six weeks are critical to your success. But with only about 90 days remaining to connect members with the care they need for your success, every day and every decision matters.

Read more

Leave a comment | Share | |

CMS Launches Patients over Paperwork Initiative Focused on Quality Measurement

Melissa Smith

As the Centers for Medicare & Medicaid Services (CMS) embarks on its Patients Over Paperwork initiative to better focus quality measurement in all programs on meaningful measures, this is an ideal time for Medicare Advantage plans to ensure they are using their data in ways which support CMS’ plans to reduce unnecessary burden, increase efficiencies, and improve the beneficiary experience.

Read more

Leave a comment | Share | |

2018 Star Ratings: Top Takeaways

Melissa Smith

In case you missed our 2018 Star Ratings webinar yesterday, here are some of our top takeaways:

Strategy is vital for sustained success. Many plans’ Star Ratings success is the product of multi-year, strategic investments to improve infrastructure, processes, culture, and execution. When Star Ratings efforts are designed only with the “short-term win” in mind, we are often limited to narrowly-defined tactics and projects – however, when they are strategically designed, Star Ratings activities can be hardwired into corporate culture and standard processes so strong Star Ratings are simply the measurement of high-quality service delivery.

Read more

Leave a comment | Share | |

2018 Star Ratings Offer Valuable Insight into Competitive MA Industry

Melissa Smith

The Centers for Medicare & Medicaid Services (CMS) release yesterday of the 2018 Star Ratings offers valuable insights into the significantly competitive Medicare Advantage (MA) industry. Here are just a few early observations and some insight into why it’s important: Read more

Leave a comment | Share | |