Marketplaces — Your Stars are coming
The Centers for Medicare & Medicaid Services (CMS) has been aggressively working in the background to establish the Star Ratings program for the Marketplaces, thus consumers will have their first quality information by 2017. Selecting a Marketplace health plan will no longer be based only on price or provider. As such, quality ratings will have a bearing on market share.
Notably, CMS is also creating future Stars for hospitals, dialysis centers, home health with nursing homes and physicians. However, it’s different for the Marketplaces.
The CMS plan starts with a beta test in 2015 by collecting both clinical data defined by HEDIS and consumer rating data collected via CAHPS. Clearly, neither of these is untested. CMS has extensive experience using both HEDIS and CAHPS to build Stars in the Medicare Advantage program; a process that has evolved over the last six years. CMS has honed its methods for conducting statistical analysis of each measure into a dynamic process that annually adds and removes measures to refine information provided to consumers. Notably, CMS is also paying rewards to higher performing plans. Even more significant for 2015, CMS has suspended its regulatory authority to terminate low performing plans. CMS is seeing the focus of these plans on improving Stars when faced with termination.
With the wealth of experience in running Stars in Medicare Advantage, this beta test is merely an assessment of collecting the information from Marketplace plans and validating data and statistical analysis methods. There will not be a long ramp up similar to what Medicare Advantage plans experienced before CMS put in Marketplace rewards and penalties.
If you haven’t already, now’s the time to put your team in place. Not just to respond to CMS setup requirements and contract with your HEDIS and CAHPS vendors, but to also begin establishing the Stars team as an operational component in your organization. It will be important to create a focus to find and monitor operations that affect Stars performance. Building the proper team and charging them with the responsibility to track and develop a Stars framework is necessary for a long-term commitment to achieving five-Star performance.
Resources
Save the Date for the Gorman Health Group 2015 Forum. Join us April 7-9, 2015 at the Gaylord National Resort and Convention Center in National Harbor, MD. Learn more about the event >>