10 Years of Star Ratings: Lessons Learned
The year 2016 marks the tenth year Medicare Advantage (MA) plan performance data has been collected for evaluation under the Centers for Medicare & Medicaid Services’ (CMS’) Star Ratings program. While we await the “new news” from CMS about new Star Ratings measures and other program updates in the impending Advance Notice, we thought it appropriate to celebrate this important milestone by looking at lessons learned through our first 10 years of Star Ratings and share some insights on how plans can leverage these lessons through the program’s continued evolution.
Star Ratings, and the quality bonuses associated with strong Star Ratings performance, put MA plans squarely on a fast-track to rapidly improve MA beneficiaries’ experience of healthcare (including quality, access, and reliability), to improve the health of the MA population, and to reduce or control the cost of healthcare within MA. As a result, MA plans have made tremendous investments of effort and resources over the past few years in the sprint to develop, deploy, and measure a whole host of tactics intended to achieve the all-important 4-Star Rating. The downside: these years of “trial and error” were often challenging, the work was often tiring for key personnel, and many plans built programs, reports, and tactics that may have worked well for yesterday’s measures but which may not be ideally suited to support CMS’ longer-term outcomes focus within the Star Ratings program. The upside: we now know, in great detail, the workflows, tactics, and population health strategies that efficiently and effectively support not only strong performance on quality measurement programs but also progress towards the Triple Aim.
During these last few days of calm before the annual Advance Notice and Call Letter season begins, here are a few strategic questions for your team to consider as you review CMS’ proposed program updates during the coming weeks:
- Is your Star Ratings work plan achieving the level of success you desire?
- How will your Star Ratings work plan need to be updated to meet CMS’ Star Ratings program updates? Are your 2016 tactics capturing the potential new measures under consideration by CMS?
- Which elements of your Star Ratings work plan are working well, and which need to be adjusted to achieve your goals?
- How are you leveraging the “basics” of Star Ratings such as care coordination, comprehensive diabetes care, medication adherence, and medication therapy management within your Medicaid, Accountable Care Organization (ACO), Marketplace, and Commercial populations?
- How effectively has your Star Ratings strategy improved outcomes and/or reduced costs?
- Do current workflows adequately address members’ social and lifestyle needs (e.g., nutrition needs, stable housing, transportation, etc.)?
- How streamlined do your providers perceive your Star Ratings programs to be? How aligned are your Star Ratings programs with the many other quality programs in which your providers participate? How can your providers best support your quality needs?
Star Ratings success requires forward-looking precision to meet the needs of your members and your providers within the constraints of your budget while delivering strong performance in areas where your population or network under-performs the national average.
We understand success isn’t easy, and evolution can be difficult. Whether you are looking to improve performance on just a few measures, need assistance interpreting the impending announcements in the Advance Notice, or are ready to more comprehensively evaluate your current Star Ratings program, we can help. For additional questions and inquiries about how Gorman Health Group can support your organization’s Star Ratings programs, please contact me directly at msmith@ghgadvisors.com.
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