Quality Ratings System
Because average just isn’t good enough
Quality ratings help enrollees select a plan that understands their needs, meets their expectations and improves their health. Success is no accident.
A QRS strategy serves as a critical foundation for success, but we understand that execution is easier said than done. Achieving and sustaining strong ratings is only possible when people at every level of the organization understand and execute carefully-designed processes that meet your enrollees’ needs.
GHG’s experts have a long history of success and know how to achieve 5-star ratings amidst the industry’s tumultuous evolution to quality-based care. We anticipate that CMS will continue adding measures, adjusting thresholds, and curving the QRS ratings to separate the remarkable from the ordinary.
Now is a critical time – Exchange plans must examine not only this year’s ratings but also their approach to person-centered healthcare across all key business functions including:
- HEDIS and healthcare quality,
- Provider contracting and engagement,
- Member services and engagement,
- Risk adjustment,
- Member and provider incentives,
- The CMS-required Quality Improvement Strategy
- Pharmacy management, and
- Data hygiene and management.
GHG has helped plans improve quality ratings for more than 15 years. Since the inception of Star Ratings and the Quality Bonus Program in Medicare Advantage, we have supported dozens of clients, including small regional plans, multi-market players, national carriers and Special Needs Plans (SNPs). We know what works and what doesn’t, and how to efficiently help you measurably improve ratings.
There is no time to delay. Whether you need to improve this year’s ratings, develop a long-term enterprise-wide QRS strategy, or develop a mechanism to monitor your progress over the next year, we can help you every step of the way. GHG’s broad portfolio of products and services, delivered by the industry’s leading experts, offer our clients unparalleled services.