Influencing Your 2017 Star Ratings: It’s Not Too Late
We are officially in the throes of the unavoidable, and much dreaded, 4th quarter Star Ratings “fire drill.” While health plan leaders (again) promise their staff and providers this year will be the last a Star Ratings fire drill will be needed, the day-by-day countdown to year-end has officially begun. As even more evidence year-end is almost upon us, Star Ratings leaders throughout the nation are putting the finishing touches on their 2016 Star Ratings work plans and counting down the days until Star Ratings measure rates and denominators are reset and the annual cycle begins again.
Because providers and pharmacies can only provide Star Ratings-impactful services to members through the end of December, many health plans may mistakenly think their ability to impact the 2017 Star Ratings is also on the countdown clock. Luckily, this couldn’t be farther from reality. Not only is this a great time to evaluate the adequacy of your 2016 Star Ratings work plans and budgets, but there are also plenty of opportunities for health plans to continue impacting their 2017 Star Ratings. Health Plans must continue to focus significant effort to ensure administrative processes capture all of the services provided to your members this year. Organizations still have several more months to influence members’ responses to next spring’s Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey and Health Outcomes Survey (HOS), and don’t forget the Call Center — Foreign Language Interpreter and TTY Availability measurement period occurs entirely during the spring of 2016.
While it is certainly true Health Plans won’t be able to provide additional clinical services after December 31st to impact 2017 Star Ratings, there is plenty of opportunity to influence the 2017 Star Ratings over the next few months. The following are a few ways you can continue to impact your 2017 Star Ratings even after December draws to a close:
- Review your Healthcare Effectiveness Data and Information Set (HEDIS®) medical record review workflows, encounter data workflows, and claims/prescription drug event (PDE) reconciliation workflows to identify any gaps or opportunities for improvement.
- Objectively review the effectiveness of your 2015 Star Ratings activities to determine what worked well, what didn’t work as well as planned, and what areas can be improved or enhanced in support your Star Ratings vision.
- Objectively evaluate the cohesiveness and coordination occurring among your internal teams and external partners and vendors to improve your members’ experience.
- Evaluate how effectively your teams are working with your high-volume providers and under-performing providers to improve Star Ratings and effectively administer risk adjustment programs.
Gorman Health Group’s (GHG’s) team of experts can help you leverage your infrastructure and workflows to improve your Star Ratings performance. Contact us today >>
Resources
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GHG understands the complexities and nuances of the Star Ratings program and measures. We know how to design programs, initiatives, and tactics to improve Star Ratings performance. From evaluating organizational strategy to developing and optimizing tactical Star Ratings work plans, our team of experts has a long history of success helping health plans achieve Star Ratings success.
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